二氧化碳激光与开放式部分喉切除术在喉鳞状细胞癌患者中的应用效果研究

Comparative study of carbon dioxide laser versus open partial laryngectomy in patients with laryngeal squamous cell carcinoma

摘要:

目的 探讨二氧化碳激光与开放式部分喉切除术在喉鳞状细胞癌患者中的应用效果与安全性。方法 采用随机数字表法将2021年2月—2024年7月山西白求恩医院收治的120例喉鳞状细胞癌患者分为观察组与对照组，每组60例。观察组接受二氧化碳激光手术，对照组接受开放式部分喉切除术。比较两组患者的基线资料、生存情况、手术指标（手术时间、术中出血量、住院时间）、喉功能［饮食评估量表（EAT-10）、洼田饮水试验］、术后视觉模拟评分法（VAS）评分及并发症发生情况。结果 截至随访结束，观察组有2例患者死亡，术后3年累计生存率为96.67%（58/60）；对照组有3例死亡，1例失访，术后3年累计生存率为93.33%（56/60）。两组3年生存率比较，差异无统计学意义（P >0.05）。观察组手术时间、术后住院时间均短于对照组（P <0.05），术中出血量少于对照组（P <0.05）。观察组手术前后EAT-10评分、洼田饮水试验评分的差值均小于对照组（P <0.05）。两组术后不同时间点VAS评分比较，结果 ①不同时间点VAS评分比较，差异有统计学意义（P <0.05）；②观察组与对照组VAS评分比较，差异有统计学意义（P <0.05），观察组VAS评分较低，相对镇痛效果较好；③两组VAS评分变化趋势比较，差异无统计学意义（P >0.05）。观察组并发症发生率低于对照组（P <0.05）。结论 二氧化碳激光在喉鳞状细胞癌的治疗中具有较好的临床疗效，手术创伤小，术后恢复快，喉功能保存较好，且并发症少。

Abstract:

Objective To investigate the therapeutic efficacy and safety of carbon dioxide laser versus open partial laryngectomy in patients with laryngeal squamous cell carcinoma.Methods Using random number tables, 120 patients with laryngeal squamous cell carcinoma treated at Shanxi Norman Bethune Hospital from February 2021 to July 2024 were enrolled. Baseline characteristics, including smoking history (39 patients) and alcohol consumption history (26 patients), showed no statistically significant differences between the groups. The survival status, surgical parameters [operation time, intraoperative blood loss, hospital stay], laryngeal function [Eating Assessment Tool (EAT-10), Kubota water-swallowing test], postoperative pain [Visual Analogue Scale (VAS) at rest], and complication rates were compared between the groups. Statistical analyses used t-tests or χ2 tests.Results In the observation group (60 cases), 2 patients died during follow-up (3-year cumulative survival rate: 96.67%). In the control group (60 cases), 3 patients died and 1 was lost to follow-up (3-year cumulative survival rate: 93.33%). There was no statistically significant difference in 3-year survival rate between the two groups (P > 0.05). The observation group had shorter operation time, less intraoperative blood loss, and shorter postoperative hospital stay than the control group (P < 0.05). The differences in EAT-10 and Kubota water-swallowing test scores before and after surgery were smaller in the observation group than in the control group (P < 0.05). For VAS scores at rest at 6, 12, 24, and 48 h postoperatively: (1) There were statistically significant differences across time points (P < 0.05); (2) The observation group had lower VAS scores than the control group (P < 0.05), indicating better analgesia; (3) There was no statistically significant difference in the trend of VAS score changes between groups (P > 0.05). The complication rate was lower in the observation group than in the control group (P < 0.05).Conclusion Carbon dioxide laser treatment demonstrates better clinical efficacy than open partial laryngectomy in laryngeal squamous cell carcinoma, with less surgical trauma, faster recovery, better preservation of laryngeal function, and fewer complications.