目的:探讨利用窄带成像技术(narrow band imaging,NBI)术前术后辅助显微支撑喉镜下CO2激光手术进行诊治的早期(T1和T2期)声门型喉癌的临床疗效.方法:回顾性分析2011年6月1日至2022年8月31日在天津市人民医院耳鼻咽喉头颈外科接受显微支撑喉镜下CO2激光手术治疗的52例早期声门型喉癌患者资料,应用NBI辅助手术的27例患者为观察组,常规支撑喉镜下CO2激光显微手术的25例患者为对照组,随访时间1～5年,总结分析2组患者术中冰冻病理结果、术后复发率、5年累积无复发生存率、并发症及嗓音恢复情况之间的差别.结果:52例患者均手术顺利,均无需行气管切开术,有1例患者出现声带粘连,但未出现呼吸困难及出血等严重并发症,并发症总发生率为1.92％.观察组5年累积无复发生存率为100％,对照组5年累积无复发生存率为77.90％,2组之间差异有统计学意义(P＜0.05).观察组较对照组的手术切缘更安全,更能准确判断肿瘤黏膜安全切缘(P＜0.05).所有患者进行了嗓音评估,嗓音障碍指数2组之间进行比较,差异无统计学意义(P＞0.05).结论:与常规支撑喉镜下CO2激光显微手术比较,NBI辅助下显微支撑喉镜下CO2激光手术切除早期声门型喉癌术后复发率低,并发症少,可有效提高5年无复发生存率,是一种更安全有效的治疗方法.
The effect of narrow band imaging in CO2 laser therapy in early-stage glottic cancer
Objective:To explore efficacy of narrow band imaging(NBI)technique in CO2 laser therapy in Ear-ly-Stage Glottic cancer.Methods:The clinical data of patients with Early-Stage Glottic cancer who underwent CO2laser vocal cord resection from June 2011 to August 2022 were retrospectively analyzed.Among these,27 pa-tients who underwent surgery assisted by NBI were assigned to the observation group,while 25 patients who un-derwent conventional CO2 laser microsurgery with a suspension laryngoscope were assigned to the control group.The differences between the two groups were analyzed in terms of intraoperative frozen pathology results,postop-erative recurrence rates,5-year cumulative disease-free survival rates,complications,and voice recovery.Results:All 52 patients were operated successfully.Temporary tracheostomy and serious complications did not occur dur-ing the operation.The postoperative patient's pronunciation was satisfactory.One patient experienced vocal cord adhesion,but there were no severe complications such as breathing difficulties or bleeding,with an overall compli-cation rate of 1.92％.Postoperative follow-up was 1-5 years.The 5 years recurrence free survival in the general group was 77.90％,and the 5 years recurrence free survival in the NBI group was 100％,the difference was sta-tistically significant(P＜0.05).NBI endoscopy is safer and more accurate than the general group in determining the safe margin of tumor mucosal resection(P＜0.05).Among the patients who accepted the voice analysis,the difference was no statistically significant(P＞0.05).Conclusion:Compared with conventional CO2 laser surgery under microscope,NBI guided laser resection of Early-Stage Glottic cancer is more accurate.NBI guided laser re-section could improve 5 years recurrence free survival rate.In a word,narrow-band imaging endoscopy can has very high value in clinical application.
laryngeal neoplasmsCO2 lasermicrosurgerynarrow band imaging
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