摘要
目的通过主观及客观评估分析早期声门型喉癌患者喉内镜下CO2激光治疗后嗓音功能恢复情况。方法回顾性分析1999年10月至2005年10月接受CO2激光手术治疗的112例声门型喉癌(Tis15例、T1a53例、T1b15例、T229例)患者的术后疗效及嗓音恢复情况,于术后6个月对103例局部无复发及4例复发后行二次激光手术后6个月的患者进行嗓音障碍指数(voice handicap index,VHI)评估表自我评分及嗓音客观评估,包括:嗓音声学分析、电声门图、最长发声时间测试;其中85名患者完成VHI问卷调查。选择50例健康男性作为正常对照组。全部病例于术后6个月进行频闪喉镜检查。声带切除方式按2000年欧洲喉科学会制定分类方案划分为5型,对比组间差异,并与正常对照组比较。结果依照Kaplan-Meier方法计算5年整体生存率为90.24%。声带上皮下切除组、声韧带下切除组与对照组嗓音参数比较,差异无统计学意义(P>0.05),VHI得分均显示正常或轻度嗓音障碍。而经肌肉声带切除组、声带完全切除组及扩大声带切除组与对照组嗓音参数比较,差异有统计学意义(P<0.05),51.8%的患者VHI分值处于中至重度嗓音障碍。结论CO2激光外科治疗早期声门型喉癌疗效确切,可较好保全喉发声功能。其中声带上皮下切除(Ⅰ型)及声韧带下切除(Ⅱ型)术后可恢复近乎正常的嗓音。
Objective To conduct a functional assessment of the voicing of the patients after the treatment with endoscopic CO2 laser for early glottic carcinoma. Methods A retrospective analysis was made on the data of 112 patients who received endoscopic CO2 laser surgery for early glottic carcinoma between October 1999 and October 2005. The assessment consisted of oncologic and vocal evaluations. VHI was administered on 85 patients. Five types of laser cordectomies were performed. Voicing results between the different types of cordectomies and a control group were compared for the further a- nalysis. Results According to the Kaplan-Meier method, the overall survival rate for 5 years accounted for 90. 24%. There were no significant differences in the vocal parameters between subepithelial,subligamental cordectomies and controls （P〉0.05）. There was, however, a significant difference between the groups of transmuscular, total and extended cordectomies and controls（P〈0.05）. The VHI scores showed all the patients in the group of typeland type Ⅱexcisions had normal voicing or mild dysphonia, and 51.8% of the patients treated with transmuscular, total and extended cordectomies had a moderate or severe dysphonia. Conclusion Endoscopic COz laser treatment of early glottic carcinoma can preserve vocal functions of the larynx and have good oncologic results. Good vocal outcomes with no differences between the controls and subepithelial and subligamental cordectomies support the use of CO2 laser endoscopic surgery as the primary choice of the treatment for early glottic cancer.
出处
《听力学及言语疾病杂志》
CAS
CSCD
2007年第6期445-447,450,共4页
Journal of Audiology and Speech Pathology
关键词
喉肿瘤
激光手术
声音质量
Laryngeal neoplasms
Laser surgery
Voice quality
