Clinical Efficacy Analysis Of Laryngeal Precancerous Lesions And Early-Stage Glottic Squamous Cell Carcinoma Undergoing Transoral CO₂ Laser Cordectomy

Objective:It aims to explore clinical efficacy and the related studies about CO₂ transoral laser microsurgery in the treatment of laryngeal precancerous lesions and early glottic carcinoma,to retrospect statistical analysis the basic information of patients.At the same time,expect to find the adverse prognostic factor and provide a reference basis for clinical treatment.Methods:This study retrospective statistical analysis the clinical date of 40 cases with early glottic carcinoma and 108 cases with laryngeal precancerous lesions,which were treated by CO₂ transoral laser microsurgery,between March 2014 and September 2020 in our hospital,and conduct follow up observation.The study of basic information（age,gender,medical history,the history of alcohol,tobacco,etc.）,median postoperative hospital,intraoperative and postoperative complications,preoperative and postoperative pathologic examination results,follow-up data,using SPSS22.0（IBM Corp,Armonk,NY）statistical software for statistical data analysis,calculated the 5-year DFS rate,the 5-year OS rate,described the life curves of patients.Try to determine the adverse prognostic factor of CO₂ transoral laser microsurgery in the treatment of laryngeal precancerous lesions and early glottic carcinoma.With P<0.05 for the difference was statistically significant.Results:There were 108 patients with laryngeal precancerous lesions who had CO₂ transoral laser microsurgery.The follow-up period ranged from 5-78 months.There were 73patients with vocal leukoplakia,which recurrence rate was 9.59%（7/73）,which cancerization rate was 1.37%（1/73）.There were 10 patients with keratosis of the larynx,which recurrence rate was 10%（1/10）,which cancerization rate was 10%（1/10）.There were 7 patients with chronic hypertrophic laryngitis,which recurrence and cancerization rate were 0%.There were 18 patients with laryngeal papilloma,which recurrence rate was38.89%（7/18）,which cancerization rate was 11.11%（2/18）.For the recurrence and cancerization rate,the four groups（P<0.05）have statistically significant difference.Involvement of the vocal fold anterior commissure had 9 cases and the recurrence rate reached 33.33%（3/9）,without anterior commissure invasion had 99 cases,the recurrence rate was 12.12%（12/99）,between the two groups with no significant difference（X²=3.104,P=0.078）.During the operation,there was no complications occurred,the blood volume was about 0-2ml.Median postoperative hospital was 4.11days（±2.44 days）.1 patient with vocal leukoplakia and 3 patients with laryngeal papilloma had the adhesion of vocal cord after surgery.The incidence of complication rate was respectively 1.37%（1/73）和16.67%（3/18）.The overall complication rate was3.7%.After single factor and multifactor comprehensive analysis,Pathologic grade is the adverse prognostic factor of CO₂ transoral laser microsurgery in the treatment of laryngeal precancerous lesions.There were 40 patients with early glottic carcinoma who had CO₂ transoral laser microsurgery.The follow-up period ranged from 6-78 months.There were 7 patients with Tis stage,22 patients with T1a stage,8 patients with T1b stage and 3 patients with T2 stage.4 patients had local recurrence.Local recurrence rate was 10%.There was 1patient with T1a stage which recurrence rate was 4.55%（1/22）.There were 2 patients with T1b stage,which recurrence rate was 25%（2/8）.There was 1 patients with T2 stage,which recurrence rate were 1/3.There was no statistically significant difference between the recurrence rate of the four groups（P=0.109）.Infringement of former united had 6cases and the recurrence rate reached 16.67%（1/6）,before Infringement of vocal cords jointly had 34 cases,the recurrence rate was 8.82%（3/34）,with no difference between the two groups（P=0.495）.At the time of surgery,the blood volume was about0-2ml.Median postoperative hospital was 4.25 days（±2.56 days）.Endotracheal tube cuff of 1 case was broken during the operation.2 cases had the adhesion of vocal cord after surgery.The overall complication rate was 7.5%.After single factor and multifactor comprehensive analysis,pathologic grade can affect early glottic carcinoma with CO₂ transoral laser microsurgery.Conclusions:1.CO₂ transoral laser microsurgery in the treatment of laryngeal precancerous lesions and early glottic carcinoma has significant Clinical efficacy,which has the advantages of less-bleeding and short hospital stay.It should be taken as the first choice for treatment of laryngeal precancerous lesions and early glottic carcinoma.2.The recurrence and cancerization rate of CO₂ transoral laser microsurgery in the treatment of laryngeal precancerous lesions is related to the clinical type.The recurrence rate,the cancerization rate and the incidence of complication of laryngeal papilloma are high.3.Pathologic grade is the adverse prognostic factor of laryngeal precancerous lesions and early-stage glottic squamous cell carcinoma undergoing transoral CO₂ laser cordectomy.