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目的:了解支撑喉镜下激光声带切除术治疗早期声门型喉癌复发的临床特点及如何选择再治疗方案。方法:采用波长为532nm的非接触式KTP激光,根据肿瘤大小和侵及深度选择不同术式:Ⅰ型声带切除术16例,Ⅱ型声带切除术63例,Ⅲ型声带切除术21例;对患者术后的复发时间、复发部位、选用术式及原发病变范围等进行分析。结果:1例在术后2个月复发,行激光手术切除,3个月后再复发,再行扩大垂直半喉切除,观察4年无复发。2例在术后3个月复发,1例在术后6个月复发,均行扩大垂直半喉切除,观察4年无复发。1例在术后1年复发,行全喉切除治疗。复发部位在前连合处4例,声带中部1例,其中原发病变T1a3例,复发率为3.1%;T1b2例,复发率为50.0%。结论:激光声带切除术后复发时间多在半年内,复发部位多在前连合处,早期发现后应首选扩大的部分喉切除术;严格选择手术适应证,熟练的手术技巧是提高疗效的关键。
Objective: To understand the clinical characteristics of laryngoscope laryngoscope laser vocal cord excision for the treatment of early glottic laryngeal cancer recurrence and how to choose the re-treatment program. Methods: Non-contact KTP laser with a wavelength of 532nm was used. According to tumor size and invasion depth, 16 cases were selected as type Ⅰ vocal cord excision, 63 cases with type Ⅱ vocal cord resection and 21 cases with type Ⅲ vocal cord excision. Patient postoperative recurrence time, recurrence site, selection of surgical procedures and primary lesions range analysis. Results: One patient recurred at 2 months after operation. Laser resection was performed. After 3 months, recurrence was repeated. Vertical resection of the laryngectomy was performed and no recurrence was observed after 4 years. Two patients relapsed 3 months after operation, and one patient recurred 6 months after operation. Both patients underwent vertical half-laryngectomy and no relapse was observed after 4 years. One patient recurred after one year and underwent total laryngectomy. The site of recurrence was 4 cases in the anterior junction and 1 case in the middle of the vocal cord. The primary lesion was T1a in 3 cases, the recurrence rate was 3.1%. In T1b2 cases, the recurrence rate was 50.0%. Conclusion: The recurrence time of laser vocal cord resection is more than half a year, and the recurrence site is more than the anterior commissure, the partial laryngectomy should be the first choice after the early detection. Strict selection of surgical indications and skilled surgical techniques are the key to improve the curative effect .