Li J J, Zhang J L, He F Y, Tang S C, Zhu Z F, Chen W X
Department of Otorhinolaryngology Head and Neck Surgery, First People's Hospital of Foshan, Foshan 528000, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2017 May 7;52(5):337-342. doi: 10.3760/cma.j.issn.1673-0860.2017.05.004.
To study the clinical outcome of transoral CO(2) laser surgery for glottic cancer involving the anterior commissure. Thirty-two cases of glottic cancer involving the anterior commissure treated by transoral CO(2) laser surgery between March 2009 and December 2013 were retrospectively reviewed. Among these cases, 27 were T1bM0M0, 5 were T2N0M0. All cases were followed-up for more than 3 years. All the 32 cases were successfully treated. Perioperative complications included injuries in the soft palate mucosa(13/32, 40.63%), loose incisors(3/32, 9.38%) and subcutaneous emphysema in the neck(2/32, 6.25%). During the follow-up period, granulation was found in all cases. Three cases had local recurrence. Two patients treated by a secondary transoral CO(2) laser surgery and the other case had total laryngectomy, all three cases were followed up for 5 years without recurrence. Two cases had regional recurrence but no primary site recurrence. One patient was treated by neck dissection, and followed up for 5 years without recurrence. The other patient died of supraclavicular and mediastinal lymph node metastasis and lung metastasis 40 months after operation. The overall 5-year survival rate was 90.6%. There was no significant difference in survival rate between T1bN0M0(92.6%) and T2N0M0(80.0%) ( χ(2)=0.788, =0.375). The overall 5-year local regional control rate was 84.4%. In T1bN0M0 lesions, the 5-year local regional control rate was 92.6%, which was significantly higher than that in T2N0M0 lesions(40.0%) ( χ(2)=9.504, =0.002). With appropriate surgical indication, detailed preoperative evaluation, good surgical skill, transoral CO(2) laser surgery may achieve satisfactory outcome in the treatment of glottic cancer involving the anterior commissure.
研究经口二氧化碳激光手术治疗累及前联合的声门癌的临床疗效。回顾性分析2009年3月至2013年12月期间32例经口二氧化碳激光手术治疗的累及前联合的声门癌患者。其中，27例为T1bM0M0，5例为T2N0M0。所有病例均随访3年以上。32例患者均成功治疗。围手术期并发症包括软腭黏膜损伤（13/32，40.63%）、松动切牙（3/32，9.38%）和颈部皮下气肿（2/32，6.25%）。随访期间，所有病例均发现肉芽组织。3例局部复发。2例患者接受二次经口二氧化碳激光手术治疗，另1例患者行全喉切除术，3例均随访5年无复发。2例区域复发但无原发部位复发。1例患者行颈部清扫术，随访5年无复发。另1例患者术后40个月死于锁骨上及纵隔淋巴结转移和肺转移。总体5年生存率为90.6%。T1bN0M0（92.6%）和T2N0M0（80.0%）患者的生存率差异无统计学意义（χ(2)=0.788，P=0.375）。总体5年局部区域控制率为84.4%。在T1bN0M0病变中，5年局部区域控制率为92.6%，显著高于T2N0M0病变（40.0%）（χ(2)=9.504，P=0.002）。选择合适的手术适应证、详细的术前评估、良好的手术技巧，经口二氧化碳激光手术在治疗累及前联合的声门癌时可能取得满意的疗效。
