支撑喉镜下CO_2激光术治疗声门型喉癌的疗效观察
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摘要
目的探讨支撑喉镜下CO_2激光术治疗早期声门型喉癌患者的疗效。方法选取本院97例早期声门型喉癌患者,按随机数字表法分成两组,对照组48例给予喉裂开喉部分切除术治疗,观察组49例实施支撑喉镜下CO_2激光术治疗,观察比较两组临床疗效、术后10 min血清α1-酸性糖蛋白(α1-AG)、铜蓝蛋白(CER)水平及嗓音功能各指标[基频微扰(Jitter)、最长发声时间(MPT)、声压级(SPL)]变化情况,并统计两组并发症发生率及生活质量(QOL)评分。结果观察组总缓解率为79. 59%(39/49),高于对照组56. 25%(27/48),差异有统计学意义(χ~2=6. 075,P=0. 014);术后10 min观察组血清α1-AG、CER水平均低于对照组,差异有统计学意义(t=2. 641,P=0. 010,t=31. 242,P=0. 000);术后2周至术后3个月两组SPL、MPT先降低后升高,Jitter先升高后降低,且观察组变化幅度小于对照组,差异有统计学意义(P <0. 05);观察组并发症发生率为2. 04%(1/49),低于对照组16. 67%(8/48),差异有统计学意义(P <0. 05);术后3个月观察组QOL评分高于对照组,差异有统计学意义(P <0. 05)。结论支撑喉镜下CO_2激光术可改善早期声门型喉癌患者应激状态及生活质量,且术后并发症发生率低,对嗓音功能影响小,疗效显著。
Objective To prospectively investigate laryngoscopy-assisted CO_2 laser in the treatment of glottic laryngeal carcinoma. Methods 97 patients with early glottic laryngeal carcinoma in our hospital were selected and divided into control group( n = 48) and observation group( n = 49) according to random number table. The control group was treated with partial laryngectomy and the observation group was treated with laryngoscopy-assisted CO_2 laser. The clinical efficacy,serum level of α1-acid glycoprotein( α1-AG)and ceruloplasmin( CER) after 10 min of the surgery and changes of the indicators of voice function [fundamental frequency jitter( jitter),the longest sound time( MPT),sound pressure level( SPL) ] were observed and compared between the two groups,and the incidence of complications and quality of life( QOL)scores were statistically compared. Results The total remission rate in the observation group was 79. 59%( 39/49),which was higher than that in the control group 56. 25%( 27/48),with statistically significant difference( χ~2= 6. 075,P = 0. 014). The levels of serum α1-AG and CER in the observation group 10 min after surgery were lower than those in the control group,with statistically significant difference( t = 2. 641,P = 0. 010,t = 31. 242,P = 0. 000). From 2 weeks after surgery to 3 months after surgery,SPL and MPT of two groups decreased first and then increased; Jitter increased first and then decreased,and the changing amplitude in the observation group was smaller than that in the control group,with statistically significant difference( P < 0. 05). The incidence of complications in the observation group was 2. 04%( 1/49),which was lower than that in the control group 16. 67%( 8/48),with statistically significant difference( P <0. 05); 3 months after surgery,the QOL score of the observation group was higher than that of the control group,with statistically significant difference( P < 0. 05). Conclusions Supporting laryngoscope CO_2 laser surgery can improve stress state and quality of life of early glottic laryngeal cancer patients,and the incidence of complications is low. It has little effect on voice function.
Objective To prospectively investigate laryngoscopy-assisted CO_2 laser in the treatment of glottic laryngeal carcinoma. Methods 97 patients with early glottic laryngeal carcinoma in our hospital were selected and divided into control group( n = 48) and observation group( n = 49) according to random number table. The control group was treated with partial laryngectomy and the observation group was treated with laryngoscopy-assisted CO_2 laser. The clinical efficacy,serum level of α1-acid glycoprotein( α1-AG)and ceruloplasmin( CER) after 10 min of the surgery and changes of the indicators of voice function [fundamental frequency jitter( jitter),the longest sound time( MPT),sound pressure level( SPL) ] were observed and compared between the two groups,and the incidence of complications and quality of life( QOL)scores were statistically compared. Results The total remission rate in the observation group was 79. 59%( 39/49),which was higher than that in the control group 56. 25%( 27/48),with statistically significant difference( χ~2= 6. 075,P = 0. 014). The levels of serum α1-AG and CER in the observation group 10 min after surgery were lower than those in the control group,with statistically significant difference( t = 2. 641,P = 0. 010,t = 31. 242,P = 0. 000). From 2 weeks after surgery to 3 months after surgery,SPL and MPT of two groups decreased first and then increased; Jitter increased first and then decreased,and the changing amplitude in the observation group was smaller than that in the control group,with statistically significant difference( P < 0. 05). The incidence of complications in the observation group was 2. 04%( 1/49),which was lower than that in the control group 16. 67%( 8/48),with statistically significant difference( P <0. 05); 3 months after surgery,the QOL score of the observation group was higher than that of the control group,with statistically significant difference( P < 0. 05). Conclusions Supporting laryngoscope CO_2 laser surgery can improve stress state and quality of life of early glottic laryngeal cancer patients,and the incidence of complications is low. It has little effect on voice function.
引文
[1]王晓凤,王丽萍,周学军.喉癌预后的相关因素分析[J].中国医师杂志,2016,18(9):1360-1362. DOI:10. 3760/cma. j.issn. 1008-1372. 2016. 09. 020.
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[9] Gong H,Wang B,Shi Y,et al. Composition and abundance of microbiota in the pharynx in patients with laryngeal carcinoma and vocal cord polyps[J]. J Microbiol,2017,55(8):648-654. DOI:10. 1007/s12275-017-6636-8.
[10]黄章模,杨田福,黄志雄,等.支撑喉镜下CO2激光治疗早期声门型喉癌的临床疗效分析[J].赣南医学院学报,2013,33(2):211-212,218. DOI:10. 3969/j. issn. 1001-5779. 2013. 02.020.
[11]孙常领,杜晓东,舒畅,等.支撑喉镜下CO2激光显微手术治疗会厌囊肿[J].中国耳鼻咽喉头颈外科,2013,20(8):445-446.
[12]白仁堂.支撑喉镜下激光声带切除术治疗早期声门型喉癌的远期疗效观察[J].中国伤残医学,2015,23(21):63-64. DOI:10. 13214/j. cnki. cjotadm. 2015. 21. 048.
[13]洪斌,李兆生,黄前进,等.显微支撑喉镜下二氧化碳激光治疗早期声门型喉癌的临床分析[J].福建医药杂志,2015,37(6):35-38.
[14]李文,史丽英,杨柳,等. T3期声门型喉癌CO2激光与喉裂开术的初步研究[J].华西医学,2013,28(1):61-63. DOI:10.7507/1002-0179. 20130015.
[15]徐相宏.支撑喉镜下CO2激光对早期声门型喉癌血清VEGF和生活质量的影响[J].中国实用医刊,2013,40(24):89-91.DOI:10. 3760/cma. j. issn. 1674-4756. 2013. 24. 040.
[16] Morato-Galán M,Caminero CMJ,Rodrigo JP,et al. Assessment of vocal quality following treatment of advanced pharyngo-laryngeal carcinoma with a protocol of organ preservation[J]. Acta Otorrinolaringol Esp,2014,65(5):283-288. DOI:10. 1016/j. otorri.2013. 12. 005.
[17]刘权忠. CO2激光喉镜显微手术治疗早期声门型喉癌疗效观察[J].安徽医药,2015,19(6):1167-1168. DOI:10. 3969/j.issn. 1009-6469. 2015. 06. 048.
[18]李晓丽,李建斌,李晓慧,等.支持喉镜下CO2激光术对早期声门型喉癌患者嗓音功能及血清相关细胞因子水平的影响[J].海南医学,2017,28(11):1759-1761. DOI:10. 3969/j.issn. 1003-6350. 2017. 11. 013.
[19]薛海翔,卞文超,李海峰,等.喉癌患者行支撑喉镜下二氧化碳激光切除术后的嗓音分析及声带新生观察[J].东南大学学报:医学版,2016,35(6):979-985. DOI:10. 3969/j. issn. 1671-6264. 2016. 06. 031.
[20]董春光,肖祥,李利,等.显微支撑喉镜下CO2激光治疗喉癌前病变[J].江苏医药,2016,42(22):2509-2510.
[21]高树峰,张少容,刘月辉,等.支撑喉镜下CO2激光微创手术治疗早期喉癌的疗效分析[J].肿瘤,2013,33(10):909-913.
[2] Yang Y,Liu J,Song F,et al. The clinical diagnostic value of target biopsy using narrow-band imaging endoscopy and accurate laryngeal carcinoma pathologic specimen acquisition[J]. Clin Otolaryngol,2017,42(1):38-45. DOI:10. 1111/coa. 12654.
[3]付文元,陶树东,闫朝晖,等.支撑喉镜下CO2激光术治疗早期声门癌疗效观察[J].山东医药,2015,55(6):80-81. DOI:10. 3969/j. issn. 1002-266X. 2015. 06. 032.
[4] Zumsteg ZS,Riaz N,Jaffery S,et al. Carotid sparing intensitymodulated radiation therapy achieves comparable locoregional control to conventional radiotherapy in T1-2N0 laryngeal carcinoma[J]. Oral Oncol,2015,51(7):716-723. DOI:10. 1016/j.oraloncology. 2015. 02. 003.
[5]唐梓轩,赵之栋,黄红星,等.支撑喉镜下CO2激光微创手术对早期喉癌的临床疗效分析[J].实用癌症杂志,2014,29(9):1180-1181,1184. DOI:10. 3969/j. issn. 1001-5930. 2014. 09.045.
[6]李小波,曹正勇.支撑喉镜下CO2激光治疗早期声门型喉癌对患者血清VEGF和β2-MG的影响[J].海南医学,2014,25(5):697-699. DOI:10. 3969/j. issn. 1003-6350. 2014. 05.0270.
[7]韩德民.喉癌-治疗与康复[M].北京:人民卫生出版社,2003.
[8]张云静,马玲国,郑朝攀,等. CO2激光治疗声门型喉癌远期疗效分析[J].山东大学耳鼻喉眼学报,2016,30(5):98-100.DOI:10. 6040/j. issn. 1673-3770. 0. 2015. 426.
[9] Gong H,Wang B,Shi Y,et al. Composition and abundance of microbiota in the pharynx in patients with laryngeal carcinoma and vocal cord polyps[J]. J Microbiol,2017,55(8):648-654. DOI:10. 1007/s12275-017-6636-8.
[10]黄章模,杨田福,黄志雄,等.支撑喉镜下CO2激光治疗早期声门型喉癌的临床疗效分析[J].赣南医学院学报,2013,33(2):211-212,218. DOI:10. 3969/j. issn. 1001-5779. 2013. 02.020.
[11]孙常领,杜晓东,舒畅,等.支撑喉镜下CO2激光显微手术治疗会厌囊肿[J].中国耳鼻咽喉头颈外科,2013,20(8):445-446.
[12]白仁堂.支撑喉镜下激光声带切除术治疗早期声门型喉癌的远期疗效观察[J].中国伤残医学,2015,23(21):63-64. DOI:10. 13214/j. cnki. cjotadm. 2015. 21. 048.
[13]洪斌,李兆生,黄前进,等.显微支撑喉镜下二氧化碳激光治疗早期声门型喉癌的临床分析[J].福建医药杂志,2015,37(6):35-38.
[14]李文,史丽英,杨柳,等. T3期声门型喉癌CO2激光与喉裂开术的初步研究[J].华西医学,2013,28(1):61-63. DOI:10.7507/1002-0179. 20130015.
[15]徐相宏.支撑喉镜下CO2激光对早期声门型喉癌血清VEGF和生活质量的影响[J].中国实用医刊,2013,40(24):89-91.DOI:10. 3760/cma. j. issn. 1674-4756. 2013. 24. 040.
[16] Morato-Galán M,Caminero CMJ,Rodrigo JP,et al. Assessment of vocal quality following treatment of advanced pharyngo-laryngeal carcinoma with a protocol of organ preservation[J]. Acta Otorrinolaringol Esp,2014,65(5):283-288. DOI:10. 1016/j. otorri.2013. 12. 005.
[17]刘权忠. CO2激光喉镜显微手术治疗早期声门型喉癌疗效观察[J].安徽医药,2015,19(6):1167-1168. DOI:10. 3969/j.issn. 1009-6469. 2015. 06. 048.
[18]李晓丽,李建斌,李晓慧,等.支持喉镜下CO2激光术对早期声门型喉癌患者嗓音功能及血清相关细胞因子水平的影响[J].海南医学,2017,28(11):1759-1761. DOI:10. 3969/j.issn. 1003-6350. 2017. 11. 013.
[19]薛海翔,卞文超,李海峰,等.喉癌患者行支撑喉镜下二氧化碳激光切除术后的嗓音分析及声带新生观察[J].东南大学学报:医学版,2016,35(6):979-985. DOI:10. 3969/j. issn. 1671-6264. 2016. 06. 031.
[20]董春光,肖祥,李利,等.显微支撑喉镜下CO2激光治疗喉癌前病变[J].江苏医药,2016,42(22):2509-2510.
[21]高树峰,张少容,刘月辉,等.支撑喉镜下CO2激光微创手术治疗早期喉癌的疗效分析[J].肿瘤,2013,33(10):909-913.