Kleinsasser O, Glanz H, Kimmich T
Hals-Nasen-Ohrenklinik, Philipps-Universität Marburg.
HNO. 1988 Oct;36(10):412-6.
Controversy began in the last century as to whether endoscopic surgery for vocal cord carcinoma carries an unnecessary risk for the patient. This controversy has been renewed since microlaryngoscopy offered the possibility of precise endoscopic resection of a vocal cord carcinoma. The most decisive prerequisites are careful assessment and adherence to strict indications. We only remove small carcinomas arising on freely mobile vocal cords by endoscopy, if the tumour is fully visible through a larger calibre operating laryngoscope. We prefer to use conventional microsurgical instruments rather than the laser. The specimen should be taken in one piece and be subjected to histological examination. Every patient must be closely followed up. A total of 76 patients with carcinomata in situ (Tis a, Tis b) and microinvasive carcinomas (T 1a, T 1b) have been followed for up to 8 years. So far not a single patient has lost his life, his larynx or his voice, or needed an additional external operation or irradiation. The results of endolaryngeal microsurgery for smaller vocal cord tumours are achieved with a minimum cost in time and money, and the least possible burden for the patient. They are scarcely inferior to primary irradiation with respect to the voice and are definitely better with respect to cure. However such results are only achieved in very carefully selected cases.
关于声带癌的内镜手术是否给患者带来不必要的风险，争议始于上世纪。自从显微喉镜检查提供了精确内镜切除声带癌的可能性后，这一争议再次出现。最关键的前提是仔细评估并严格遵循适应证。如果肿瘤能通过较大口径的手术喉镜完全看清，我们才通过内镜切除自由活动声带表面的小癌灶。我们更倾向于使用传统显微手术器械而非激光。标本应完整取下并进行组织学检查。每位患者都必须密切随访。共有76例原位癌（Tis a、Tis b）和微浸润癌（T 1a、T 1b）患者接受了长达8年的随访。到目前为止，没有一位患者死亡、失去喉部或嗓音，也没有患者需要额外的外部手术或放疗。对于较小的声带肿瘤，喉内显微手术的结果在时间和金钱方面成本最低，对患者的负担也最小。就嗓音而言，其结果与初次放疗相比几乎不差，而就治愈率而言肯定更好。然而，只有在经过非常严格挑选的病例中才能取得这样的结果。
