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目的:采用声学参数客观评价CO2激光治疗Tis-T1声门型喉癌术后不同时期的嗓音康复状况。方法:CO2激光治疗早期声门型喉癌41例,其中Tis23例(Tis组),T1N0M018例(T1组)。术中CO2激光切除病变的范围根据肿瘤的不同分期而定,通过术中冷冻病理检查保证手术切缘阴性。对30例健康中老年男性(正常组)及41例患者的手术前后不同时期(术前1天、术后3个月、6个月及1年)行嗓音声学检测(包括基频、基频微扰、振幅微扰、声门噪声能量及最长声时),比较评价术后不同时期嗓音康复情况。结果:术后病理结果示,23例为鳞状上皮重度不典型增生,16例为高分化鳞状细胞癌,2例为中分化鳞状细胞癌。3例患者术中出现腭舌弓黏膜撕裂,所有患者均未出现呼吸困难,并在术后3d恢复正常进食。全部患者随访满1年,均未复发。Tis组和T1组患者术后不同时期的基频、基频微扰、振幅微扰比较差异均有统计学意义(P<0.05),而声门噪声能量及最长声时在术后6个月及1年时的差异无统计学意义(P>0.05)。结论:CO2激光治疗早期声门型喉癌疗效确切,患者术后嗓音功能较术前有不同程度改善,嗓音质量随康复时间的推移逐渐好转,部分反映嗓音功能的客观参数在术后半年之后逐渐趋于稳定。
OBJECTIVE: To objectively evaluate the voice rehabilitation status of CO2 laser in the treatment of Tis-T1 glottic cancer by acoustic parameters. Methods: CO2 laser was used to treat 41 cases of early glottic laryngeal carcinoma, of which Tis was 23 cases (Tis group) and T1N0M018 cases (T1 group). The range of intraoperative CO2 laser ablation lesions according to the different stages of the tumor, by intraoperative frozen pathology to ensure that the surgical margin negative. Thirty patients (normal group) and 41 patients (aged 1 day, 3 months, 6 months and 1 year) before and after operation underwent acoustic examination (including fundamental frequency and fundamental frequency Perturbation, amplitude perturbation, glottis noise energy and the longest voice) were compared and evaluated for voice rehabilitation in different periods after operation. Results: The postoperative pathological findings showed that 23 cases had severe dysplasia of squamous epithelium, 16 cases of well differentiated squamous cell carcinoma and 2 cases of moderately differentiated squamous cell carcinoma. Three cases of patients with velopharyngeal mucosal tear, all patients did not appear dyspnea, and returned to normal after 3 days of eating. All patients were followed up for 1 year, no recurrence. The differences of fundamental frequency, fundamental frequency perturbation and amplitude perturbation in Tis group and T1 group were statistically significant at different periods (P <0.05), while the glottis noise energy and the longest sound time were 6 Month and 1 year difference was not statistically significant (P> 0.05). Conclusion: CO2 laser treatment of early glottic laryngeal cancer is effective, the postoperative voice function improved to varying degrees compared with preoperative, voice quality gradually improved with the passage of time, partially reflecting the objective parameters of voice function gradually after six months becoming steady.