Bruzgielewicz Antoni, Osuch-Wójcikiewicz Ewa, Januszek Grzegorz, Szwedowicz Paweł, Domeracka-Kołodziej Anna, Zawadzka Renata, Niemczyk Kazimierz
Katedra i Klinika Otolaryngologii Warszawskiego Uniwersytetu Medycznego.
Otolaryngol Pol. 2011 Sep;65(5 Suppl):78-84. doi: 10.1016/S0030-6657(11)70713-2.
CO(2) laser endoscopic surgery, introduction in the treatment of early glottic malignancies in the early seventies is the method has been well studied in such cases, and its utility for these lesions is well-established. Transoral resection with the CO(2) laser, open partial laryngectomy and radiotherapy are the main options for treatment of early laryngeal cancer. As all the therapies are all equally effective in controlling an early glottic cancer the choice of treatment must consider such factors as possible complications, functional outcome and patient compliance. For properly selected patients the laser therapy provides equivalent oncologic outcomes when compared to traditional surgical therapies while improving the functional aspects of postoperative speech, voice and swallowing. Its advantages over open surgery include quicker recovery, less morbidity, fewer side effects and greater cost-effectiveness too. The disadvantages of radiotherapy are: duration of treatment, loss of time for work and social activities, higher rate of other possible complications, and partial preclusion of further conservative salvage surgery. Some authors report radiotherapy offers the better quality of voice but further investigations are needed to compare the voice following endoscopic resections with that obtained after radiotherapy.
The aim of the study was to analyze the character of the peri- and postoperative complications after CO(2) laser endoscopic surgery for the early glottis cancer.
[corrected] This was a retrospective study of a files of 55 patients (7 female and 48 male) in age range 38-85 with early glottic carcinoma (Tis - T2) treated by cordectomy. Diagnosis was based on histopathological examination of the biopsy specimen of the lesion and ultrasonographical examination of the lymphonodules of the neck. Videolaryngostroboscopy and acustic analize of the voice was complicated. All of them underwent one of the types of cordectomy using a CO(2) laser, between 2007 and 2010. Cordectomies were categorized according to the classification of the European Laryngological Society (2000 and rev. 2007). In our series most cordectomies were type III 24 patients. Type IV - 2 patients, type Va - 18, type Vb - 4, type Vc - 6 and type VI - 1 patient. We observed peri-and postoperative complication and functional result of the treatment such as quality of voice and swallowing difficulties.
Among 55 patient postoperative bleeding was the most commonly seen complication. It appeared in 34 of them (62%). All the cases of bleeding were easy to control. In 23 cases pain and mild laryngeal oedema were observed. It resolved in 3-4 day after medical treatment. None of our patient required tracheotomy. Eight patients needed revision procedures: four due to granulation tissue formation, two due to adhesion and another two due to laryngocele. This entire patient was manageable locally with repeated surgery. Our functional data, including stroboscopic findings and perceptual and objective voice evaluations, demonstrate that patients who underwent cordectomy and foniatric rehabilitation presents social efficient voice but with pathological components. All the patients have good long-term swallowing function.
二氧化碳激光内镜手术于70年代初被引入用于早期声门恶性肿瘤的治疗，该方法在此类病例中已得到充分研究，其对这些病变的效用也已得到充分确立。经口二氧化碳激光切除术、开放性部分喉切除术和放射治疗是早期喉癌的主要治疗选择。由于所有这些治疗方法在控制早期声门癌方面同样有效，治疗的选择必须考虑诸如可能的并发症、功能结果和患者依从性等因素。对于经过适当选择的患者，与传统手术治疗相比，激光治疗在肿瘤学结果方面相当，同时改善了术后言语、嗓音和吞咽的功能方面。它相对于开放手术的优点包括恢复更快、发病率更低、副作用更少以及成本效益更高。放射治疗的缺点是：治疗持续时间、工作和社交活动时间的损失、其他可能并发症的发生率更高以及进一步保守挽救手术的部分排除。一些作者报告放射治疗提供了更好的嗓音质量，但需要进一步研究以比较内镜切除术后的嗓音与放射治疗后的嗓音。
本研究的目的是分析早期声门癌二氧化碳激光内镜手术后围手术期和术后并发症的特点。
这是一项对55例患者（7例女性和48例男性）的回顾性研究，年龄范围为38 - 85岁，患有早期声门癌（Tis - T2），接受了声带切除术。诊断基于病变活检标本的组织病理学检查和颈部淋巴结的超声检查。同时进行了视频喉镜频闪检查和声门声学分析。所有患者在2007年至2010年间接受了使用二氧化碳激光的一种类型的声带切除术。声带切除术根据欧洲喉科学会（2000年及2007年修订版）的分类进行。在我们的系列中，大多数声带切除术为III型（24例患者）。IV型 - 2例患者，Va型 - 18例，Vb型 - 4例，Vc型 - 6例，VI型 - 1例患者。我们观察了围手术期和术后并发症以及治疗的功能结果，如嗓音质量和吞咽困难。
在55例患者中，术后出血是最常见的并发症。34例患者出现出血（62%）。所有出血病例都易于控制。23例患者观察到疼痛和轻度喉水肿。经药物治疗后3 - 4天缓解。我们的患者均无需气管切开术。8例患者需要进行修复手术：4例由于肉芽组织形成，2例由于粘连，另外2例由于喉膨出。所有这些患者通过重复手术在局部均可处理。我们的功能数据，包括频闪检查结果以及感知和客观嗓音评估，表明接受声带切除术和嗓音康复治疗的患者具有社交有效的嗓音，但存在病理成分。所有患者都有良好的长期吞咽功能。
