低温等离子射频消融手术治疗早期喉癌疗效观察
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摘要
目的:探讨低温等离子射频消融手术治疗早期喉癌(Tis、T_1和T_2)的安全性、有效性及预后。方法:回顾性分析202例经直达喉镜下低温等离子射频消融手术治疗早期喉癌患者的临床资料,其中Tis期34例(16.83%),T_(1a)N_0M_0期49例(24.26%),T_(1b)N_0M_0期50例(24.75%),T_2N_0M_0期69例(34.16%)。对手术患者进行术后严密随访,随访6～60个月,中位随访时间29个月。结果:202例患者中,165例(81.68%)未见复发,均获得了良好的手术效果,均未出现术后出血、呼吸困难等严重并发症;37例(18.32%)术后复发,其中Tis期1例(0.50%),T_(1a)期7例(3.47%),T_(1b)期7例(3.47%),T_2期22例(10.89%)。复发患者中13例行全喉切除术(其中5例复发进展为T_3期,8例进展为T_4期),分别为T_(1a)期1例、T_(1b)期2例、T_2期10例;4例行垂直半喉切除手术,分别为T_(1a)期3例、T_2期1例;5例再次行等离子射频消融手术,分别为T_(1b)期3例、T_2期2例,后均未再次复发;1例患者喉部未见明显复发但颈部淋巴结转移,遂行单纯颈淋巴结清扫术;1例T_2期患者复发后为解除喉阻塞单纯行气管切开术,后未进一步治疗;3例患者复发后行放化疗好转;死亡9例,其中行放化疗后死亡5例,复发后放弃治疗4例。结论:低温等离子射频消融手术治疗早期喉癌患者在术后保留喉功能、减少手术创伤方面较喉癌传统手术具有较大的优势,并可以获得较为满意的疗效,但在部分T_2期患者的手术适应证选择上仍需慎重。
Objective:To evaluate the safety,efficacy and prognosis of low-temperature plasma radiofrequency coblation for early-stage laryngeal cancer(Tis,T_(1a)nd T_2).Method:A retrospective analysis of 202 patients with early-stage laryngeal cancer who underwent the low-temperature radiofrequency coblation surgery,including 34 cases of Tis(16.83%),49 cases of stage T_(1a)N_0 M_0(24.26%),50 cases of stage T_(1b)N_0 M_0(24.75%)and 69 cases of stage T2 N0 M0(34.16%).Surgical patients were followed up closely for 6 to 60 months,with a median follow-up of 29 months.Result:Of the 202 patients,165(81.68%)had no recurrence and achieved good surgical results.None of them suffered severe complications such as post-operative hemorrhage and asphyxia.37 cases(18.32%)had recurrence,including 1 case(0.50%)in stage Tis,7 cases(3.47%)in stage T_(1a),7 cases(3.47%)in stage T_(1b),and 22 cases(10.89%)in stage T2.Thirteen patients who had recurrence underwent total laryngectomy(5 of which had a recurrence of T_3 and 8 of which progressed to T4),including 1 in the stage T_(1a),2 in the stage T_(1b),and 10 in the stage T_2.Vertical hemilaryngectomy were performed in 4 cases,3 cases of stage T_(1a)and 1 case of stage T_2;5 cases underwent plasma radiofrequency coblation again,including 3 cases of stage T_(1b)and 2 cases of stage T_2,no recurrence was found in all the patients;1 patient had no obvious recurrence in the larynx but had cervical lymph node metastasis,radical neck dissection was performed;1 patient with stage T_2 recurrence was treated with a tracheotomy to relieve laryngeal obstruction without further treatment;3 cases showed improvement by radiotherapy and chemotherapy treatment after recurrence;9 death cases,5 patients died after radiotherapy and chemotherapy,and 4 patients stopped getting treatment after recurrence.Conclusion:Low-temperature radiofrequency coblation surgery for patients with early-stage laryngeal cancer has great advantages in the preservation of laryngeal function and reduction of surgical trauma after surgery compared with traditional surgical method,and can obtain satisfactory results,but the selection of surgical indications for some patients with clinical stage T_2 is still need to be carefully considered.
Objective:To evaluate the safety,efficacy and prognosis of low-temperature plasma radiofrequency coblation for early-stage laryngeal cancer(Tis,T_(1a)nd T_2).Method:A retrospective analysis of 202 patients with early-stage laryngeal cancer who underwent the low-temperature radiofrequency coblation surgery,including 34 cases of Tis(16.83%),49 cases of stage T_(1a)N_0 M_0(24.26%),50 cases of stage T_(1b)N_0 M_0(24.75%)and 69 cases of stage T2 N0 M0(34.16%).Surgical patients were followed up closely for 6 to 60 months,with a median follow-up of 29 months.Result:Of the 202 patients,165(81.68%)had no recurrence and achieved good surgical results.None of them suffered severe complications such as post-operative hemorrhage and asphyxia.37 cases(18.32%)had recurrence,including 1 case(0.50%)in stage Tis,7 cases(3.47%)in stage T_(1a),7 cases(3.47%)in stage T_(1b),and 22 cases(10.89%)in stage T2.Thirteen patients who had recurrence underwent total laryngectomy(5 of which had a recurrence of T_3 and 8 of which progressed to T4),including 1 in the stage T_(1a),2 in the stage T_(1b),and 10 in the stage T_2.Vertical hemilaryngectomy were performed in 4 cases,3 cases of stage T_(1a)and 1 case of stage T_2;5 cases underwent plasma radiofrequency coblation again,including 3 cases of stage T_(1b)and 2 cases of stage T_2,no recurrence was found in all the patients;1 patient had no obvious recurrence in the larynx but had cervical lymph node metastasis,radical neck dissection was performed;1 patient with stage T_2 recurrence was treated with a tracheotomy to relieve laryngeal obstruction without further treatment;3 cases showed improvement by radiotherapy and chemotherapy treatment after recurrence;9 death cases,5 patients died after radiotherapy and chemotherapy,and 4 patients stopped getting treatment after recurrence.Conclusion:Low-temperature radiofrequency coblation surgery for patients with early-stage laryngeal cancer has great advantages in the preservation of laryngeal function and reduction of surgical trauma after surgery compared with traditional surgical method,and can obtain satisfactory results,but the selection of surgical indications for some patients with clinical stage T_2 is still need to be carefully considered.
引文
[1]张庆丰,张晶晶.等离子射频治疗早期声门型喉癌的疗效分析[J].临床耳鼻咽喉头颈外科杂志,2017,31(14):1127-1129.
[2] CARNEY A S,TIMMS M S,MARNANE CN,et al.Radiofrequency coblation for the resection of head and neck malignancies[J].Otolaryngol Head Neck Surg,2008,138:81-85.
[3] REMACLE M,ECKEL H E,ANTONELLI A,et al.Endoscopic cordectomy.A proposal for a classification by the Working Committee,European Laryngological Society[J].Eur Arch Otorhinolaryngol,2000,257:227-231.
[4]李京旻,马衍,向明亮.早期喉癌腔镜外科手术及放疗治疗进展[J].国际耳鼻咽喉头颈外科杂志,2018,42(1):32-36.
[5] LIM Y J,WU H G,KWON T K,et al.Long-term outcome of definitive radiotherapy for early glottic cancer:prognostic factors and patterns of local failure[J].Cancer Res Treat,2015,47:862-870.
[6] BRUMUND K T,GUTIERREZ-FONSECA R,GARCIA D,et al.Frontolateral vertical partial laryngectomy without tracheotomy for invasive squamous cell carcinoma of the true vocal cord:a 25-year experience[J].Ann Otol Rhinol Laryngol,2005,114:314-322.
[7]黄志刚,韩德民,于振坤.CO2激光手术治疗声门型喉癌疗效分析[J].中华耳鼻咽喉头颈外科杂志,2002,37(3):212-219.
[8] LALLEMANT B,CHAMBON G,GARREL R,et al.Transoral robotic surgery for the treatment of T1-T2carcinoma of the larynx:preliminary study[J].Laryngoscope,2013,123:2485-2490.
[9] STRONG M S,JAKO G J.Laser surgery in the larynx.Early clinical experience with continuous CO2laser[J].Ann Otol Rhinol Laryngol,1972,81:791-798.
[10]STEINER W,AMBROSCH P.Endoscopic laser surgery of the upper aerodigestive tract[M].Stuttgart:Thieme,2000:97-100.
[11]PERETTI G,PIAZZA C,COCCO D,et al.Transoral CO2laser treatment for T(is)-T(3)glottic cancer:the University of Brescia experience on 595patients[J].Head Neck,2010,32:977-983.
[12]WINIARSKI P,LEWANDOWSKI A,GRECZKA G,et al.Primary and salvage laser surgery of 341glottic cancers-Comparison of treatment outcomes between University Head Neck Tertiary Referral Center and Local Head Neck Department[J].Lasers Surg Med,2018,50:311-318.
[13]张庆丰.耳鼻咽喉等离子手术学[M].北京:人民卫生出版社,2014:1-4.
[14]CARNEY A S,EVANS A S,MIRZA S,et al.Radiofrequency coblation for treatment of advanced laryngotracheal recurrent respiratory papillomatosis[J].J Laryngol Otol,2010,124:510-514.
[15]LIU B,CHENG L,MING H,et al.Treatment of the early-stage glottic cancer using low-temperature radiofrequency coblation[J].J Cancer Res Ther,2016,12:830-833.
[2] CARNEY A S,TIMMS M S,MARNANE CN,et al.Radiofrequency coblation for the resection of head and neck malignancies[J].Otolaryngol Head Neck Surg,2008,138:81-85.
[3] REMACLE M,ECKEL H E,ANTONELLI A,et al.Endoscopic cordectomy.A proposal for a classification by the Working Committee,European Laryngological Society[J].Eur Arch Otorhinolaryngol,2000,257:227-231.
[4]李京旻,马衍,向明亮.早期喉癌腔镜外科手术及放疗治疗进展[J].国际耳鼻咽喉头颈外科杂志,2018,42(1):32-36.
[5] LIM Y J,WU H G,KWON T K,et al.Long-term outcome of definitive radiotherapy for early glottic cancer:prognostic factors and patterns of local failure[J].Cancer Res Treat,2015,47:862-870.
[6] BRUMUND K T,GUTIERREZ-FONSECA R,GARCIA D,et al.Frontolateral vertical partial laryngectomy without tracheotomy for invasive squamous cell carcinoma of the true vocal cord:a 25-year experience[J].Ann Otol Rhinol Laryngol,2005,114:314-322.
[7]黄志刚,韩德民,于振坤.CO2激光手术治疗声门型喉癌疗效分析[J].中华耳鼻咽喉头颈外科杂志,2002,37(3):212-219.
[8] LALLEMANT B,CHAMBON G,GARREL R,et al.Transoral robotic surgery for the treatment of T1-T2carcinoma of the larynx:preliminary study[J].Laryngoscope,2013,123:2485-2490.
[9] STRONG M S,JAKO G J.Laser surgery in the larynx.Early clinical experience with continuous CO2laser[J].Ann Otol Rhinol Laryngol,1972,81:791-798.
[10]STEINER W,AMBROSCH P.Endoscopic laser surgery of the upper aerodigestive tract[M].Stuttgart:Thieme,2000:97-100.
[11]PERETTI G,PIAZZA C,COCCO D,et al.Transoral CO2laser treatment for T(is)-T(3)glottic cancer:the University of Brescia experience on 595patients[J].Head Neck,2010,32:977-983.
[12]WINIARSKI P,LEWANDOWSKI A,GRECZKA G,et al.Primary and salvage laser surgery of 341glottic cancers-Comparison of treatment outcomes between University Head Neck Tertiary Referral Center and Local Head Neck Department[J].Lasers Surg Med,2018,50:311-318.
[13]张庆丰.耳鼻咽喉等离子手术学[M].北京:人民卫生出版社,2014:1-4.
[14]CARNEY A S,EVANS A S,MIRZA S,et al.Radiofrequency coblation for treatment of advanced laryngotracheal recurrent respiratory papillomatosis[J].J Laryngol Otol,2010,124:510-514.
[15]LIU B,CHENG L,MING H,et al.Treatment of the early-stage glottic cancer using low-temperature radiofrequency coblation[J].J Cancer Res Ther,2016,12:830-833.