CO2激光与掺钕钇铝石榴石激光治疗声门型喉癌手术并发症的比较研究

摘要

目的 比较CO2和掺钕钇铝石榴石(Nd:YAG)两种激光治疗声门型喉癌的手术并发症的发生率,并探讨减少并发症的有效方法.方法 采用回顾性分析1999年1月1日至2008年12月31日在北京大学第一医院耳鼻咽喉头颈外科接受支撑喉镜下CO2和Nd:YAG激光治疗的83例患者的临床资料,比较两组并发症的发生率.CO2激光治疗组32例,其中原位癌2例,T1N0M021例,T2N0M0 8例,T3N0M0 1例,采用非接触式脉冲激光;Nd:YAG激光治疗组51例,原位癌3例,T1N0M0 36例,T1N2M0 3例,T2N0M0 9例,采用光纤接触式激光.结果 CO2激光并发症共4例(12.5%),其中喉软骨膜炎1例(3.1%),舌体麻木1例(3.1%),门齿松动1例(3.1%),皮下气肿1例(3.1%);Nd:YAG激光并发症27例(52.9%),其中术后出血2例(3.9%),呼吸困难5例(9.8%),喉软骨膜炎7例(13.7%),肺部感染4例(7.8%),舌体麻木2例(3.9%),咽颈瘘1例(2.0%),声带固定4例(7.8%),喉狭窄2例(3.9%).结论 Nd:YAG激光较CO2激光更易发生手术并发症,少数并发症需要紧急处理,通过适当预防措施可以减轻并发症,避免严重后果.%Objective To compare the complications in transoral CO2 and Nd: YAG laser surgery for the treatment of laryngeal carcinoma. Methods Retrospective analysis of 83 cases of glottic laryngeal carcinoma treated with laser surgery from January 1,1999 to December 31,2008 was carried out. Thirty-two cases were treated with the CO2 laser, including Tis(2 cases), T1N0M0 (21 cases), T2N0M0 (8 cases),and T3N0M0 (1 case). Fifty-one cases were treated with the Nd:YAG laser, including Tis (3 cases),T1N0M0 (36 cases), T1N2M0 (3 cases), and T2N0M0 (9 cases). Results Four complications ( 12.5% )occurred in the CO2 laser group. There was 1 local infection ( 3.1% ), 1 numbness of the tongue ( 3.1% ),1 odontoseisis (3. 1 % ), and 1 subcutaneous emphysema (3.1% ). Twenty-seven complications (52.9%)occurred in 19 patients in the Nd: YAG laser group. There were postoperative bleeding 2(3.9% ), dyspnea 5 ( 9. 8% ), local infection 7 ( 13.7% ), aspiration pneumonia 4 ( 7. 8% ), numbness of the tongue 2(3. 9% ), pharyngeal cutaneous fistula 1 (2.0%), vocal cord fixation 4 (7.8%), and laryngostenosis 2(3.9% ). Conclusion More complications were observed in the patients with Nd: YAG laser surgery when compared to the patients with CO2 laser surgery.