Clinical Study Of CO₂ Laser Combined With Radiofrequency Ablation In The Treatment Of Early Glottic Cancer

BackgroundEarly glottic cancer(EGC)is a common malignant tumor of the head and neck,accounting for about 30%of all laryngeal cancers,mainly occurring in middle-aged and elderly men.The main clinical manifestation is hoarseness,sometimes accompanied by cough,throat discomfort,dyspnea and so on.Early glottic cancer is common clinically with obvious initial symptoms.Early detection,early diagnosis and timely treatment lead to high quality of life and fewer complications.Laryngoscope,ultrasound,neck CT and other examinations are helpful for the diagnosis of the disease.Surgery is the main treatment for early glottic cancer.The traditional surgical method is open partial laryngectomy through external cervical approach,but the surgical trauma is large,the postoperative complications are many,and the quality of life of the patients is reduced.In recent years,with the development of medical technology and the popularization of microscope and endoscope,the application of minimally invasive techniques such as CO2 laser and low-temperature plasma radiofrequency ablation in the treatment of early glottic cancer has the advantages of smaller trauma,less pain and fewer complications,so it is selected by many scholars,but each of them has its own shortcomings.ObjectiveThe purpose of this study was to investigate the diagnosis of early glottic cancer and to evaluate the clinical application and efficacy of endoscopic CO2 laser combined with low-temperature plasma radiofrequency ablation.MethodThe medical information of 40 cases of early glottic cancer treated by endoscopic CO2 laser combined with low-temperature plasma radiofrequency ablation were analyzed retrospectively at the First Affiliated Hospital of Zhengzhou University from July 2018 to November 2020.The basic clinical data included sex,age,location,history of smoking and drinking,clinical manifestation,imaging examination,pathology,visual analogue score of postoperative pain within 24 hours,postoperative complications and recurrence.The average follow-up was 17.6 months.ResultThe 40 cases were all male,with age ranging from 47 to 88 years old,52.5%on the left,35.0%on the right,and 12.5%on both sides.Anterior commissure was involved in 12 cases(30.0%).The results of routine pathology or intraoperative rapid freezing pathology were all squamous cell carcinoma.None of the 40 patients were lost.5 cases of recurrence were treated by CO2 laser combined with low-temperature plasma radiofrequency ablation under laryngoscope for the first time with a recurrence rate of 12.5%,in which total laryngectomy was performed in 2 cases,vertical partial laryngectomy in 1 case,selective neck dissection in 1 case,and combined surgery with tracheotomy in 1 case.Granulation tissue occurred in 9 cases(22.5%)after operation,and it disappeared in 1～6 months.Mild vocal cord adhesion occurred in 4 patients(10.0%).Postoperative vocal function was good in 36 cases(90.0%),poor in 2 cases(5.0%)and lost in 2 cases(5.0%)after total laryngectomy.All csaes had no other complications such as bleeding,dysphagia,dyspnea,pharyngeal fistula and so on.Conclusion①Endoscopic CO2 laser combined with low-temperature plasma radiofrequency ablation in the treatment of early glottic cancer can make up for the deficiency of the two single modes and improve the efficiency of operation.It is an effective and feasible surgical method.②In the examination of early glottic cancer,electronic laryngoscope(fibrolaryngoscope)should be the first choice because of its simple operation,less pain and clear image.Preoperative cervical ultrasound,CT and MRI examination can further know the scope and nature of the lesion,its relationship with surrounding anatomy and lymph node metastasis,which is of great significance for the diagnosis of the disease and the formulation of surgical plan.