Vilaseca Isabel, Bernal-Sprekelsen Manuel
Servicio ORL, Hospital Clínic, Facultad de Medicina, Universitat de Barcelona, Barcelona, Spain.
Acta Otorrinolaringol Esp. 2013 Mar-Apr;64(2):140-9. doi: 10.1016/j.otorri.2012.01.013. Epub 2012 Apr 13.
In recent years, surgical treatment of laryngeal cancer has evolved towards transoral resections. Transoral laser microsurgery (TLM) combines microscopic control with the precise cutting and coagulation capability that laser equipment has, making it possible to remove laryngeal tumours by the transoral approach, with very good oncological and functional outcomes. In early tumours, local control with TLM has been proved to be as good as in open surgery and totally comparable to that achieved under radiation protocols, at a much lower cost. Consequently, TLM is presently considered a first line treatment in early laryngeal cancer. These good oncological and functional results have led to an increase in TLM indications for intermediate or advanced carcinomas. In this article we review the role of TLM in the treatment of locally advanced tumours of the larynx, with special emphasis on appropriate patient selection and different technical considerations. Although TLM is not presently considered a standard treatment for locally advanced laryngeal tumours, the outcomes published in the literature are very encouraging, with results comparable to other treatment alternatives in appropriately selected patients. Compared to external surgical procedures, TLM reduces patient morbidity, provides faster recovery and makes it possible to avoid tracheotomy in a high number of patients.
近年来，喉癌的外科治疗已朝着经口切除术发展。经口激光显微手术（TLM）将显微镜下的控制与激光设备精确的切割和凝固能力相结合，使得经口途径切除喉部肿瘤成为可能，具有非常好的肿瘤学和功能学结果。在早期肿瘤中，已证明TLM的局部控制效果与开放手术一样好，并且与放疗方案下的效果完全可比，成本却低得多。因此，TLM目前被认为是早期喉癌的一线治疗方法。这些良好的肿瘤学和功能学结果导致TLM在中期或晚期癌中的适应证有所增加。在本文中，我们回顾了TLM在喉局部晚期肿瘤治疗中的作用，特别强调了合适的患者选择和不同的技术考量。尽管目前TLM不被认为是喉局部晚期肿瘤的标准治疗方法，但文献中发表的结果非常令人鼓舞，在适当选择的患者中，其结果与其他治疗选择相当。与外部手术相比，TLM降低了患者的发病率，恢复更快，并使大量患者能够避免气管切开术。
