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目的研究分析CO_2激光手术治疗声门型喉癌的临床疗效,并对其局部复发与前联合受侵犯的相关性进行探讨,以期为临床诊治提供理论依据。方法入选2010年1月至2015年12月于徐州医科大学附属淮安医院就诊,并进行手术的声门型喉癌患者78例作为研究对象,按手术方法不同分为观察组48例和对照组30例,观察组予CO_2激光手术治疗,对照组予传统喉裂开切除治疗,针对两组患者手术效果进行对比分析;观察组根据前联合受累情况分为前联合受累组18例和前联合未受累组30例,对照组前联合受累组12例和前联合未受累组18例,术后随访1年,比较两组患者局部复发情况。结果不同手术方法的两组患者嗓音学分析和电声门图各项参数进行比较分析,结果显示观察组在嗓音学分析和电声门图各项参数与对照组患者比较,差异具有统计学意义,观察组术后嗓音恢复较好(P<0.05);观察组不良反应发生率为2.08%,明显低于对照组(23.3%),差异具有统计学意义(P<0.05);前联合受累患者局部复发率为33.3%,明显高于前联合未受累组(6.7%),差异有统计学意义(P<0.05)。结论 CO_2激光手术治疗早期声门型喉癌手术创伤小、并发症较少、术后嗓音恢复较好;前联合受累的早期声门型喉癌CO_2激光仍可作为主要手术方式,但必须把握好分期,对T2以上分期患者须谨慎,术前要充分研判病变范围等,以降低复发率。
Objective To study the clinical efficacy of CO_2 laser in the treatment of glottic laryngeal cancer and to explore the correlation between the local recurrence and the invasion of the frontal joint larynx in order to provide a theoretical basis for clinical diagnosis and treatment. Methods From January 2010 to December 2015, 78 cases of glottic laryngeal cancer who were treated in Huai’an Hospital Affiliated to Xuzhou Medical University were enrolled in this study. According to the different surgical methods, they were divided into observation group (48 cases) and control group (30 cases) Cases, the observation group to CO_2 laser surgery, the control group to the traditional laryngectomy for the treatment of patients with surgery for the comparative analysis of the effect of the two groups were divided into the former group according to the former joint involvement of 18 cases and the former combined with uninvolved 30 cases in the control group, 12 cases in the control group before combination and 18 cases in the previous group without involvement. The patients were followed up for 1 year. The local recurrence was compared between the two groups. Results The voice analysis and electroacoustic imaging of the two groups of patients with different surgical methods were compared and analyzed. The results showed that there were significant differences in the parameters of vocal analysis and electroacoustic imaging between the observation group and the control group (P <0.05). The incidence of adverse reactions in the observation group was 2.08%, which was significantly lower than that in the control group (23.3%), the difference was statistically significant (P <0.05) The local recurrence rate was 33.3%, which was significantly higher than that of the former uninvolved group (6.7%), the difference was statistically significant (P <0.05). Conclusions CO_2 laser treatment of early glottic laryngeal cancer has less trauma and fewer complications, and the postoperative recovery of vocal cords is better. The CO_2 laser of the early glottic laryngeal carcinoma involved in the former may still be used as the primary surgical method, but it must be well controlled Staging, patients with T2 or more staging should be cautious, the full assessment of the lesion before surgery to reduce the recurrence rate.