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窄带成像技术引导下显微CO2激光手术与常规显微CO2激光手术在声带不典型增生治疗中的应用比较

Narrow band imaging-guided microscopic CO2 laser surgery versus conventional microscopic CO2 laser surgery in treatment of vocal cord atypical hyperplasia

    摘要
  • 摘要:
    目的 比较窄带成像技术(NBI)引导下显微CO2激光手术与常规显微CO2激光手术治疗声带不典型增生患者的临床效果。
    方法 选取90例声带不典型增生患者为研究对象，依据手术方式的不同分为常规组(43例，常规显微CO2激光手术)和NBI引导组(47例，NBI引导下显微CO2激光手术)。比较2组切缘阴性率、并发症发生率、复发率及手术前后嗓音学指标(基频微扰、振幅微扰、声门噪声能量)、炎症因子C反应蛋白(CRP)、白细胞介素-6(IL-6)水平。
    结果 NBI引导组激光手术后首次送检切缘阴性率为97.87%, 高于常规组的86.05%, 差异有统计学意义(P < 0.05)。术后, 2组基频微扰、振幅微扰及声门噪声能量均低于术前，差异有统计学意义(P < 0.05), 但2组差异无统计学意义(P>0.05)。术后, 2组CRP、IL-6水平均低于术前，差异有统计学意义(P < 0.05), 但2组间差异无统计学意义(P>0.05)。NBI引导组的并发症发生率为4.26%, 常规组为9.30%, 差异无统计学意义(P>0.05)。随访6个月至2年, NBI引导组复发率为2.13%, 常规组为6.98%, 差异无统计学意义(P>0.05)。
    结论 与常规显微CO2激光手术相比, NBI引导下显微CO2激光手术治疗声带不典型增生可更精准地确定病变及周边黏膜切缘范围，减少术中病检次数，但两者对术后嗓音学指标、炎症因子、并发症、复发率等的影响相似。

     

    Abstract:
    Objective To compare the clinical efficacy of narrow band imaging (NBI)-guided microscopic CO2 laser surgery and conventional microscopic CO2 laser surgery in treatment of patients with vocal cord atypical hyperplasia.
    Methods A total of 90 patients with vocal cord atypical hyperplasia were enrolled as study subjects. Based on different surgical approaches, they were divided into conventional group (43 cases, undergoing conventional microscopic CO2 laser surgery) and NBI-guided group (47 cases, undergoing NBI-guided microscopic CO2 laser surgery). The negative margin rate, complication rate, recurrence rate, and the levels of voice-related parameters (jitter, shimmer, noise-to-harmonic ratio) and inflammatory factorsC-reactive protein (CRP), interleukin-6 (IL-6)before and after surgery were compared between the two groups.
    Results The negative margin rate of the first-time biopsy after laser surgery in the NBI-guided group was 97.87%, which was higher than 86.05% in the conventional group, with a statistically significant difference (P < 0.05). After surgery, the jitter, shimmer and noise-to-harmonic ratio in both groups were lower than those before surgery, with statistically significant differences (P < 0.05), but there was no statistically significant difference between the two groups (P>0.05). After surgery, the levels of CRP and IL-6 in both groups were lower than those before surgery, with statistically significant differences (P < 0.05), but there was no statistically significant difference between the two groups (P>0.05). The complication rate was 4.26% in the NBI-guided group, and 9.30% in the conventional group, with no statistically significant between-group difference (P>0.05). During a follow-up of 6 months to 2 years, the recurrence rate in the NBI-guided group was 2.13% and 6.98% in the conventional group, with no statistically significant between-group difference (P>0.05).
    Conclusion Compared with conventional microscopic CO2 laser surgery, NBI-guided microscopic CO2 laser surgery can more precisely determine the range of the lesion and the surrounding mucosal margins and reduce the number of intraoperative biopsies in the treatment of vocal cord atypical hyperplasia. However, the two surgical methods have similar impacts on postoperative voice-related parameters, inflammatory factors, complications and recurrence rates.

     

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