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目的:探讨内镜CO2激光声带切除术治疗T1声门型喉癌是否应常规切除甲杓肌。方法:回顾性分析内镜CO2激光治疗T1声门型喉癌57例患者的临床和病理资料。其中Tis 7例,T1a47例,T1b3例;声带切除术Ⅰ、Ⅱ型9例,Ⅲ、Ⅳ、Ⅴ型48例。将48例包括甲杓肌的声带切除标本病理切片进行重新阅片。生存率的计算用Kaplan-Meier方法。结果:随访4~119个月(平均41.5个月),死亡4例,失访8例,5年生存率89.1%,5年疾病别生存率96.3%,5年无瘤生存率78.1%。局部复发10例(17.5%),颈部转移1例,甲杓肌受侵5例(8.8%)。挽救手术包括:喉部分切除术6例,喉全切除术3例,颈淋巴结清扫术1例,喉全切除术及颈淋巴结清扫术1例。术后放疗2例。喉保存率93.0%(53/57)。结论:T1声门癌可侵及甲杓肌,内镜CO2激光声带切除治疗T1声门癌时,甲杓肌的切除应根据术前和术中肿瘤的范围和侵润深度,分别实施不同类型的切除。正确判断肿瘤的范围和甲杓肌受侵深度有助于减少术后局部复发和提高发声质量。
Objective: To investigate whether endoscopic CO2 laser vocal cordctomy for the treatment of T1 glottic laryngeal cancer should be routine removal of the thyroid muscle. Methods: The clinical and pathological data of 57 patients with T1 glottic laryngeal carcinoma treated by endoscopic CO2 laser were retrospectively analyzed. There were 7 cases of Tis, 47 cases of T1a and 3 cases of T1b. There were 9 cases of type Ⅰ and Ⅱ, 48 cases of type Ⅲ, Ⅳ and Ⅴ. Forty-eight vocal cord resections including pathognomonic muscles were re-read. Survival was calculated using the Kaplan-Meier method. Results: The follow-up ranged from 4 to 119 months (average 41.5 months). Four patients died, 8 were lost to follow-up, and the 5-year survival rate was 89.1%. The five-year disease-free survival rate was 96.3% and the five-year disease-free survival rate was 78.1%. Local recurrence in 10 cases (17.5%), neck metastases in 1 case, 5 cases of graded kerato muscular muscle (8.8%). Salvage operations included 6 cases of partial laryngectomy, 3 cases of total laryngectomy, 1 case of cervical lymph node dissection, 1 case of total laryngectomy and neck dissection. Postoperative radiotherapy in 2 cases. Throat preservation rate of 93.0% (53/57). Conclusions: T1 glottic carcinoma can invade and fasciadora, endoscopic CO2 laser vocal cord excision for the treatment of T1 glottic cancer, and the removal of the muscle should be based on preoperative and intraoperative tumor size and depth of invasion, respectively, the implementation of different types The removal. Correctly determine the scope of the tumor and the depth of invasion of the thyroid muscle can help reduce local recurrence and improve the sound quality.