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目的观察应用嗓音显微手术治疗早期声门癌的远期疗效。方法1989—1997年采用嗓音显微外科技术对44例声带早期癌(T1a)进行了手术治疗。声带早期癌按病变的侵袭深度分为:原位癌(5例)、低侵袭癌(33例)和侵袭癌(6例)。原位癌和低侵袭癌采用微瓣切除技术;对侵袭癌则采取激光切除声带,切缘经过微波或激光处理的方法。每例患者均进行术前、术中和术后录像,术后常规病理送检,并进行长期随访。随访最长时间为11年,最短时间5年。结果应用微瓣切除方法的38例原位癌和低侵袭癌中有6例在手术后随访的2~3年内发现局部复发,局部复发率为15·8%。6例复发患者再次行微瓣切除,其中1例在10年内经历3次微瓣切除手术。1例失随访后1年再次因肿瘤复发就诊,后改喉全切除手术。微瓣切除术病例失访4例,其余随访5年以上均存活,5年生存率为89·5%(失访以死亡计)。应用声带切除术的6例早期侵袭癌中2例于术后2个月发现肿瘤复发而行喉切除术,1例失随访后3年复发改喉全切除术,1例梭型细胞癌术后采用局部放射治疗。声带切除术局部复发率为4/6;3例在3年内死亡,1例3年后失访,2例存活5年以上。结论对病变局限的早期癌,嗓音显微手术不仅能有效地治愈疾病,同时能保护和维持正常的发声功能。对于病变局限在黏膜表面的声带早期癌,嗓音显微手术的微瓣技术不仅是有效的微创治疗措施,同时微瓣切除的病变标本经连续切片的病理诊断也成为了早期声带癌诊断及鉴别诊断的“金标准”。
Objective To observe the long-term efficacy of voice microsurgical treatment of early glottic cancer. Methods From 1989 to 1997, 44 patients with early diagnosis of vocal cord cancer (T1a) were treated by voice microsurgery. Vocal cord cancer by depth of invasion depth is divided into: carcinoma in situ (5 cases), low invasive cancer (33 cases) and invasive cancer (6 cases). In situ carcinoma and low invasive cancer using micro-valve resection technique; for invasive cancer is to take the laser cutting vocal cords, cutting edge after microwave or laser treatment methods. Each patient underwent preoperative, intraoperative and postoperative recordings, postoperative routine pathological examination, and long-term follow-up. The longest follow-up time is 11 years, the shortest time is 5 years. Results The local recurrence was found in 38 cases of carcinoma in situ and 6 cases of low invasive carcinoma using microsurgical resection within 2 to 3 years after follow-up. The local recurrence rate was 15.8%. Six patients with recurrence were retrospectively retrospectively performed. One patient underwent three microsurgical resections within 10 years. One case of missed follow-up 1 year again due to tumor recurrence after the change of total laryngectomy surgery. Microstomy cases were lost in 4 cases, the rest were followed up for more than 5 years, the 5-year survival rate was 89.5% (loss of follow-up to death). Two cases of early invasive carcinoma using vocal cord excision showed tumor recurrence and laryngectomy 2 months after operation, one case of recurrent laryngectomy after 3 years of missed follow-up and one case of shuttle cell carcinoma after operation Using local radiotherapy. Vocal cord resection of the local recurrence rate was 4/6; 3 cases died within 3 years, 1 case 3 years after the lost, 2 cases survived more than 5 years. Conclusions Early cancer and vocal microsurgery with limited lesions not only can effectively cure the disease, but also can protect and maintain the normal vocal function. Micromembranous technique of vocal microsurgery is not only an effective minimally invasive treatment for the early stage of vocal cord lesions with mucosal lesions, but also the diagnosis and differential diagnosis of early vocal cord cancer by the pathological diagnosis of microsectomy specimens by serial sections Diagnostic “gold standard.”