低温等离子射频消融术与CO2激光治疗早期声门型喉癌疗效比较

摘要

目的：比较低温等离子射频消融术与 CO2激光治疗早期声门型喉癌的临床疗效。方法选取2007年10月～2012年12月行手术治疗的104例早期声门型喉癌（Tis 、T1a 、T1b ）患者，其中64例行低温等离子射频消融术（等离子组），40例行 CO2激光切除术（CO2激光组）。记录并比较两组手术时间、术后第二日疼痛程度[视觉模拟评分法（visual analog scale ，VAS）]评分；所有患者于术后一周、1个月及3个月行电子喉镜及嗓音声学分析，并进行随访观察。结果等离子组平均手术时间为8．75±1．62 min ，CO2激光组平均手术时间为11．82±1．51 min ，等离子组优于 CO2激光组（P＜0．05）。术后第二日 VAS 评分等离子组（2．79±0．47分）与 CO2激光组（2．96±0．64分）组间差异无统计学意义（P＞0．05）。等离子组术后1个月粘膜恢复情况好于 CO2激光组（χ2＝13．842，P＜0．05）。单因素重复测量分析结果显示：等离子组及 CO2激光组术后嗓音声学指标 jitter 、shimmer 、 HNR 随术后时间延长逐渐好转，在术后3个时间点的变化差异有统计学意义（P＜0．05），且呈线性变化趋势。多因素重复测量方差分析结果显示：嗓音声学指标（jitter 、shimmer 、HNR）在术后3个时间点两组间差异均有统计学意义（P＜0．05）。等离子组与 CO2激光组术后3年生存率、局部复发率、侵及前联合复发率、前联合术后粘连率组间差异均无统计学意义（P＞0．05）。两组所有患者均未行气管切开术，术后无呛咳，无呼吸困难，无严重疼痛及咯血等严重并发症。结论低温等离子射频消融术与 CO2激光治疗早期声门型喉癌均较安全、有效，而低温等离子射频消融术手术时间较 CO2激光手术短，术后一月粘膜恢复及嗓音恢复均优于 CO2激光手术。%Objective To comparison curative effects between radiofrequency coblation and CO 2 laser in treat‐ment of early glottic carcinoma .Methods A total of 104 patients with early glottic cancer (Tis ,T1a ,T1b ) were treated in our department from October 2007 to December 2012 .Among them 64 cases underwent radiofrequency ablation (radiofrequency group) while 40 cases underwent CO2 laser resection (CO2 laser group) .The operation time and the postoperative pain VAS scores were recorded .All of the patients were examined by electronic laryngoscopy and a‐coustic analysis in 1 week ,1 month ,3 months after surgery .Results The mean operation time of radiofrequency group was 8 .75 ± 1 .62(min)and CO2 laser group was 11 .82 ± 1 .51(min) .The radiofrequency group was better than CO2 laser group(P < 0 .05) .The differences of postoperative pain VAS score was not statistically significant be ‐tween radiofrequency group(2 .79 ± 0 .47) and CO2 laser group (2 .96 ± 0 .64)(P> 0 .05) .The mucosal recovery of radiofrequency group in 1 month after surgery was better than the CO2 laser group (χ2 = 13 .842 ,P< 0 .05) .Subjects in radiofrequency group and CO2 laser group showed statistical significance and linear trends in jitter ,shimmer ,HNR over time by univariate test of repeated measurement ANOVA (P < 0 .05) .The differences of acoustic parameters (jitter ,shimmer ,HNR)between radiofrequency group and CO 2 laser group were statistically significant by multiva‐riate test of repeated measurement ANOVA (P< 0 .05) .The differences of 3 - years survival rate ,local recurrence rate ,recurrence rate with anterior commissure involved and postoperative adhesion rate with anterior commissure in ‐volved were not statistically significant between radiofrequency group and CO 2 laser group (P > 0 .05) .All of the patients had not underwent tracheotomy .They did not have cough ,dyspnea ,severe pain ,hemoptysis ,serious compli‐cations after surgery .Conclusion Both radiofrequency coblation and CO 2 laser are safe and effective surgical meth‐ods in the treatment of early glottic carcinoma .The operation time of radiofrequency coblation is shorter than CO 2 laser surgery .The mucosal recovery in 1 month after surgery and acoustic recovery of radiofrequenay coblation are all better than that of the CO2 laser surgery .