三种不同手术方式治疗Ⅰ/Ⅱ期声门型喉癌优势对比分析

马兵良 任刚 石玉叶 徐珏

[摘要] 目的 比較喉裂开术、二氧化碳（CO2）激光术及低温等离子射频消融术治疗Ⅰ/Ⅱ期声门型喉癌优势。 方法 回顾性分析2015年4月至2017年4月我院收治的102例Ⅰ/Ⅱ期声门型喉癌患者临床资料。根据手术方式分为A组、B组、C组，每组各34例。A组患者为常规喉裂开术治疗，B组患者为CO2激光术治疗，C组患者为低温等离子射频消融术治疗。比较三组患者手术时间、术中出血量、住院时间、VAS评分、吞咽功能、术后并发症、术后1年与3年累积生存率及语音功能。 结果 与B组、A组相比，C组术中出血量明显更少，手术和住院时间更短，VAS评分明显更低（C组<B组<A组），差异有统计学意义（P<0.05）;术后C组患者的基频微扰、振幅微扰均明显低于B组、A组（C组<B组<A组），但谐噪比明显高于B组、A组（C组>B组>A组），差异有统计学意义（P<0.05）;C组与B组吞咽功能有效率明显高于A组，差异有统计学意义（χ2=6.572，P=0.037）;C组患者术后并发症总发生率明显低于B组、A组，差异有统计学意义（χ2=9.459，P=0.009）;三组患者术后1年与3年累积生存率比较，差异均无统计学意义（P>0.05）。 结论 三种手术方式在治疗Ⅰ/Ⅱ期声门型喉癌方面各具有优势，术后累积生存率无明显差异。但低温等离子射频消融术能够有效缩短住院时间，降低术后并发症，其临床应用更加安全，临床应根据患者病情选取适当术式。

[关键词] Ⅰ/Ⅱ期声门型喉癌;喉裂开术;二氧化碳激光术;低温等离子射频消融术

[中图分类号] R739          [文献标识码] B          [文章编号] 1673-9701（2021）30-0081-04

[Abstract] Objective To compare the advantages of laryngeal fissure，CO2 laser and low temperature plasma radiofrequency ablation in the treatment of stage Ⅰ/Ⅱ glottic laryngeal carcinoma. Methods The clinical data of 102 patients with stage Ⅰ/Ⅱ glottic laryngeal carcinoma who were admitted to our hospital from April 2015 to April 2017 were retrospectively analyzed. According to the surgical procedures in the data，the patients were divided into Group A，Group B and Group C，with 34 cases in each. Group A was treated with conventional laryngeal fissure; Group B was treated with CO2 laser; Group C was treated with low temperature plasma radiofrequency ablation. The operative times，intraoperative blood losses，lengths of hospital stay，VAS scores， swallowing functions，postoperative complications，cumulative survival rates 1-year and 3-year after surgery，and speech functions were compared among the three groups. Results Compared with Group B and Group A， the intraoperative blood loss was significantly less， the operation time and lengths of hospital stay were shorter， and VAS scoreswere lower in Group C（Group C<Group B<Group A），with significant difference（P<0.05）. Postoperative fundamental frequency perturbation and amplitude perturbation in Group C were significantly lower than those in Group B and Group A （Group C < Group B < Group A），with significant difference（P<0.05）. But the harmonic noise ratio was significantly higher than that in Group B and Group A （Group C>Group B>Group A），with significant difference（P<0.05）. The effective rate of swallowing function in Group C and Group B were significantly higher than that in Group A，with significant difference（χ2=6.572，P=0.037）. The total incidence of postoperative complications in Group C was significantly lower than that in Group B and Group A，with significant difference （χ2=9.459，P=0.009）. No significant differences in the 1-year and 3-year cumulative survival rates were observed among the three groups （P>0.05）. Conclusion Laryngeal fissure，CO2 laser and low temperature plasma radiofrequency ablation have their respective advantages in the treatment of stage Ⅰ/Ⅱ glottic laryngeal carcinoma，and no significant difference in postoperative cumulative survival rate exists. However，low temperature plasma radiofrequency ablation can effectively shorten the length of hospital stay and reduce postoperative complications，and its clinical application is safer. Therefore，appropriate surgical procedures should be selected according to the actual conditions of patients.

[Key words] Stage Ⅰ/Ⅱ glottic laryngeal carcinoma; Laryngeal fissure; CO2 laser; Low temperature plasma radiofrequency ablation

作为喉癌的常见类型，声门型喉癌早期一般无特异症状，仅表现为咳嗽、声音，但晚期可导致患者出现呼吸困难、失声及放射性耳痛等，严重时出现死亡，因此尽早发现并治疗能够提高预后生存率[1-2]。……