不同术式治疗喉恶性肿瘤的效果及并发症分析

doi:10.3969/j.issn.1674-8115.2023.11.011

摘要/Abstract

摘要：

目的·对比研究二氧化碳激光喉切除术和开放式部分喉切除术治疗喉恶性肿瘤的效果，及其并发症发生情况。方法·收集2013年1月至2018年1月于上海交通大学医学院附属仁济医院就诊的101例Ⅰ~Ⅲ期喉鳞状细胞癌患者临床资料，根据手术方式的不同分为开放组和微创组。开放组（57例）采用开放式部分喉切除治疗，微创组（44例）采用二氧化碳激光喉切除治疗。通过电话、门诊复诊等方式进行回访，按照不同临床分期（Ⅰ期、Ⅱ期、Ⅲ期）及肿瘤发生部位（声门型、非声门型）分别对2组患者的手术时间、术后喉黏膜水肿时间、术后住院时间、5年生存率、并发症发生率、复发率进行比较。结果·微创组患者手术时间、术后喉黏膜水肿时间、术后住院时间均短于开放组（均P<0.05）。2组之间相同临床分期、声门型患者的5年生存率比较，差异无统计学意义（均P>0.05）；而2组非声门型患者的5年生存率比较（开放组62.5% vs微创组0），差异有统计学意义（P<0.05）。微创组中，有3例出现并发症，其中发热1例，肺部感染2例；开放组中，有14例出现并发症，其中发热5例，肺部感染7例，咽瘘2例。微创组患者并发症发生率（6.82%，3/44）低于开放组（24.60%，14/57），差异有统计学意义（P<0.05）；微创组Ⅱ期及声门型患者的并发症发生率均显著低于开放组（P<0.05）。2组患者复发率（开放组10.53% vs微创组2.27%）比较，差异无统计学意义（P>0.05）。结论·与开放式部分喉切除术相比，二氧化碳激光喉切除治疗早中期喉恶性肿瘤，患者术后恢复更快，并发症发生率低，值得推广。

关键词: 喉恶性肿瘤, 开放式部分喉切除, 二氧化碳激光喉切除

Abstract:

Objective ·To compare the effects and complications of carbon dioxide laser laryngectomy and open partial laryngectomy in the treatment of laryngeal carcinoma. Methods ·Clinical data of 101 patients with stage Ⅰ-Ⅲ laryngeal squamous cell carcinoma admitted to Renji Hospital, Shanghai Jiao Tong University School of Medicine from January 2013 to January 2018 were selected and divided into open surgery group and minimally invasive group according to different surgical methods. The open surgery group received open partial laryngectomy (57 cases), and the minimally invasive group received carbon dioxide laser laryngectomy (44 cases). Follow-up visits were made by telephone and outpatient visits, and the operation time, postoperative laryngeal mucosa edema time, length of stay, 5-year survival rate, complication rate and recurrence rate of the two groups were compared in the different clinical stages (stage Ⅰ, stage Ⅱ, and stage Ⅲ) and tumor locations (glottic type and non-glottic type). Results ·The operation time, postoperative laryngeal mucosa edema time and length of stay of the minimally invasive group were shorter than those of the open surgery group (P<0.05). Comparison of the 5-year survival rates of patients with the same clinical stage and glottic type between the two groups showed no statistically significant difference (both P>0.05); while comparison of the 5-year survival rates of patients with non-glottic type between the two groups (62.5% in the open surgery group vs 0 in the minimally invasive group) showed a statistically significant difference (P<0.05). In the minimally invasive group, there were 3 cases of complications, including 1 case of fever and 2 cases of lung infection; in the open surgery group, there were 14 cases of complications, including 5 cases of fever, 7 cases of lung infection and 2 cases of pharyngeal fistula. The complication rate of patients in the minimally invasive group (6.82%, 3/44) was lower than that in the open surgery group (24.60%, 14/57), and the difference was statistically significant (P<0.05); the complication rate of patients with stage Ⅱ and glottic type in the minimally invasive group was significantly lower than that in the open surgery group (P<0.05). Comparing the recurrence rate of patients in the two groups (10.53% in the open surgery group vs 2.27% in the minimally invasive group), the difference was not statistically significant (P>0.05). Conclusion ·Compared with open partial laryngectomy, carbon dioxide laser laryngectomy has faster postoperative recovery and lower complication rate in the treatment of early and middle laryngeal malignant tumors, so it is worth promoting.

Key words: laryngeal carcinoma, open partial laryngectomy, carbon dioxide laser laryngectomy

中图分类号:

R767.91

江永权, 戴利, 陈天宏, 王晶烁, 张奕, 李吉平. 不同术式治疗喉恶性肿瘤的效果及并发症分析[J]. 上海交通大学学报（医学版）, 2023, 43(11): 1430-1435.

JIANG Yongquan, DAI Li, CHEN Tianhong, WANG Jingshuo, ZHANG Yi, LI Jiping. Effect and complications of different surgical methods in treatment of laryngeal carcinoma[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(11): 1430-1435.

图/表 2

图1 2组患者手术时间、术后住院时间、术后喉黏膜水肿时间比较Note： A. Comparison of operation time, length of stay and postoperative laryngeal mucosal edema time between the two groups of total patients. B?D.Comparison of operation time (B), length of stay (C) and postoperative laryngeal mucosal edema time (D) between the two groups of patients with different stages and types. ①P=0.000, ②P=0.002, compared with minimally invasive group.

Fig 1 Comparison of operation time, length of stay and postoperative laryngeal mucosal edema time between the two groups

图2 2组患者生存曲线比较Note： A. Total patients; B. Stage Ⅰ; C. Stage Ⅱ; D. Stage Ⅲ; E. Glottic laryngeal carcinoma; F. Non-glottic laryngeal carcinoma.

Fig 2 Comparison of survival curve between the two groups

参考文献 24

1	CAVALIERE M, BISOGNO A, SCARPA A, et al. Biomarkers of laryngeal squamous cell carcinoma: a review[J]. Ann Diagn Pathol, 2021, 54: 151787.
2	SHAPIRA U, WARSHAVSKY A, MUHANNA N, et al. Laryngectomy-free survival after salvage partial laryngectomy: a systematic review and meta-analysis[J]. Eur Arch Otorhinolaryngol, 2022, 279(6): 3021-3027.
3	徐伟, 吕正华, 马聚珂, 等. 环状软骨上部分喉切除术的临床疗效分析[J]. 中华耳鼻咽喉头颈外科杂志, 2019, 54(5): 339-342.
	XU W, LÜ Z H, MA J K, et al. The oncologic and functional outcomes of supracricoid partial laryngectomy for the treatment of laryngeal cancer[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2019, 54(5): 339-342.
4	杨娜, 段佳丽, 金日群. 早期声门型喉恶性肿瘤治疗研究进展[J]. 齐齐哈尔医学院学报, 2022, 43(17): 1673-1677.
	YANG N, DUAN J L, JIN R Q. The research progress on the treatment of early glottic laryngeal malignant tumor[J]. Journal of Qiqihar Medical University, 2022, 43(17): 1673-1677.
5	BAIRD B J, SUNG C K, BEADLE B M, et al. Treatment of early-stage laryngeal cancer: a comparison of treatment options[J]. Oral Oncol, 2018, 87: 8-16.
6	OBID R, REDLICH M, TOMEH C. The treatment of laryngeal cancer[J]. Oral Maxillofac Surg Clin N Am, 2019, 31(1): 1-11.
7	DU L, LI H, ZHU C, et al. Incidence and mortality of laryngeal cancer in China, 2011[J]. Chin J Cancer Res, 2015, 27(1): 52-58.
8	TALATI V M, URBAN M J, PATEL T R, et al. Laryngeal chondrosarcoma characteristics and survival analysis in the national cancer database[J]. Otolaryngol Head Neck Surg, 2022, 166(1): 101-108.
9	CLIN B, GRAMOND C, THAON I, et al. Head and neck cancer and asbestos exposure[J]. Occup Environ Med, 2022, 79(10): 690-696.
10	KOZHANOV A L, KOZHANOV L G. Modern aspects of organ-preserving surgery for laryngeal cancer[J]. Vestn Otorinolaringol, 2022, 87(2): 44-50.
11	HANS S, BAUDOUIN R, CIRCIU M P, et al. Open partial laryngectomies: history of laryngeal cancer surgery[J]. J Clin Med, 2022, 11(18): 5352.
12	ZENGA J, GOLDSMITH T, BUNTING G, et al. State of the art: rehabilitation of speech and swallowing after total laryngectomy[J]. Oral Oncol, 2018, 86: 38-47.
13	KEMPS G J F, KREBBERS I, PILZ W, et al. Affective symptoms and swallow-specific quality of life in total laryngectomy patients[J]. Head Neck, 2020, 42(11): 3179-3187.
14	WULFF N B, DALTON S O, WESSEL I, et al. Health-related quality of life, dysphagia, voice problems, depression, and anxiety after total laryngectomy[J]. Laryngoscope, 2022, 132(5): 980-988.
15	WULFF N B, HØJAGER A, WESSEL I, et al. Health-related quality of life following total laryngectomy: a systematic review[J]. Laryngoscope, 2021, 131(4): 820-831.
16	PARSEL S M, IAROCCI A L, GASTAÑADUY M, et al. Reflux disease and laryngeal neoplasia in nonsmokers and nondrinkers[J]. Otolaryngol Head Neck Surg, 2020, 163(3): 560-562.
17	VILASECA I, XAVIER AVILÉS-JURADO F, LEHRER E, et al. CO₂-TOLMS for laryngeal cancer in the elderly, pushing the boundaries of partial laryngectomy[J]. Oral Oncol, 2022, 134: 106088.
18	SEO J H, KIM Y D, PARK C S, et al. Hypertension is associated with oral, laryngeal, and esophageal cancer: a nationwide population-based study[J]. Sci Rep, 2020, 10(1): 10291.
19	陈艺丰, 王丽萍, 吉鹏, 等. 不同类型喉部分切除术对喉癌患者吞咽功能的影响[J]. 听力学及言语疾病杂志, 2023, 31(1): 71-74.
	CHEN Y F, WANG L P, JI P, et al. Effect of different types of partial laryngectomy on swallowing function in patients with laryngeal cancer[J]. Journal of Audiology and Speech Pathology, 2023, 31(1):71-74.
20	PEZDIREC M, STROJAN P, BOLTEZAR I H. Swallowing disorders after treatment for head and neck cancer[J]. Radiol Oncol, 2019, 53(2): 225-230.
21	LUO C, LV K, LIU Q, et al. Comparison of laser microsurgery and open partial laryngectomy for T1-2 laryngeal cancer treatment[J]. Ann Transl Med, 2021, 9(6): 464.
22	BADWAL J S. Total laryngectomy for treatment of T4 laryngeal cancer: trends and survival outcomes[J]. Pol Przegl Chir, 2018, 91(3): 30-37.
23	王正, 许晓燕, 卫旭东. 低温等离子喉部分切除术治疗早期声门型喉癌的临床疗效分析[J]. 中国眼耳鼻喉科杂志, 2023, 23(1):77-81.
	WANG Z, XU X Y, WEI X D. Therapeutic effect of coblation on early glottic laryngeal carcinoma[J]. Chinese Journal of Ophthalmology and Otorhinolaryngology, 2023, 23(1): 77-81.
24	袁立功, 毛友生. 食管癌喉返神经旁淋巴结清扫的价值及相关并发症[J]. 中华肿瘤杂志, 2022, 44(7): 712-716.
	YUAN L G, MAO Y S. The value and related complications of lymph node dissection along bilateral recurrent laryngeal nerves in esophageal cancer patients[J]. Chinese Journal of Oncology, 2022, 44(7): 712-716.