Department of Otolaryngology and Head and Neck Surgery, Aintree University Hospitals NHS Trust, Liverpool, UK,
Eur Arch Otorhinolaryngol. 2014 Feb;271(2):367-72. doi: 10.1007/s00405-013-2501-5. Epub 2013 May 4.
The objective of this study was to compare transoral laser microsurgery (TLM) with lip-split mandibulotomy (LSM) and radial forearm free-flap reconstruction, for the resection of squamous cell carcinoma of the oropharynx (SCCOP). This study is designed as a case-control study matching 24 patients treated with TLM for SCCOP with those treated with LSM. Patients were matched by age (in 5-year epochs), sex, TNM stage, tumour sub site and type of neck dissection. Each group comprised 20 males and 4 females (mean age 56 years). Seven patients treated with TLM had an elective tracheostomy compared with all patients undergoing LSM. Moreover, the time for decanulation was reduced in patients undergoing tracheostomy for TLM. Although similar rates of patients were able to swallow to some degree on discharge, 29% of patients having LSM were discharged requiring enterostomy feeding compared with 4% of patients treated using TLM. Of those able to swallow on discharge, patients who had TLM resumed swallowing in half the time taken for those having LSM. Moreover, those treated with TLM remained in hospital for half the length of time than those treated with LSM. Due to these factors, overall cost for TLM is reduced in comparison with LSM. In comparison with LSM, TLM for the treatment of SCCOP results in fewer tracheostomies and shorter time to decanulation; a quicker recovery of swallowing function and a reduced length of hospital stay. As a result of this, treatment with TLM is on average cheaper. These factors should be considered when deciding on the surgical treatment of a patient with SCCOP.
本研究旨在比较经口激光微创手术（TLM）与唇裂下颌骨切开术（LSM）和游离前臂皮瓣重建术治疗口咽鳞状细胞癌（SCCOP）的疗效。本研究设计为病例对照研究，将 24 例接受 TLM 治疗的 SCCOP 患者与接受 LSM 治疗的患者进行匹配。患者按年龄（每 5 年为一个时期）、性别、TNM 分期、肿瘤亚部位和颈部清扫术类型进行匹配。每组包括 20 名男性和 4 名女性（平均年龄 56 岁）。与接受 LSM 的所有患者相比，接受 TLM 治疗的 7 例患者行选择性气管切开术。此外，TLM 行气管切开术的患者拔管时间缩短。虽然出院时能够在一定程度上吞咽的患者比例相似，但行 LSM 的患者中有 29%需要肠内营养喂养，而接受 TLM 治疗的患者只有 4%。在能够出院时吞咽的患者中，接受 TLM 治疗的患者恢复吞咽的时间是接受 LSM 治疗的患者的一半。此外，接受 TLM 治疗的患者住院时间比接受 LSM 治疗的患者缩短一半。由于这些因素，与 LSM 相比，TLM 的总体费用降低。与 LSM 相比，TLM 治疗 SCCOP 导致更少的气管切开术和更短的拔管时间；吞咽功能恢复更快，住院时间缩短。因此，TLM 的治疗费用平均更低。在决定 SCCOP 患者的手术治疗方案时，应考虑这些因素。
