Surgical Strategy Of Low-temperature Plasma Radiofrequency Coblation For Glottic Carcinoma

Objective:To analyze the the related factors of recurrence of glottic carcinoma after low-temperature plasma radiofrequency coblation,study the possible causes of postoperative secondary bleeding,and explore the surgical strategy.Methods:A retrospective analysis of 72 patients with glottic carcinoma(T₁N₀M₀58cases,T₂N_0-1M₀7 cases,T₃N_0-1M₀7 cases)who received low temperature plasma radiofrequency coblation for the first time in the Department of Otolaryngology,the Second Affiliated Hospital of Dalian Medical University from May 2016 to April 2020.All patients had no distant metastasis.The surgery for all patients was performed by the same professor in our department.Follow-up was performed by regular reexamination of laryngoscopy and telephone follow-up in the outpatient department.The follow-up time ranged from 6 months to 52 months,and the median follow-up time was 30months.Used SPSS 19.0 statistical software,there was a significant statistical difference with P<0.05.Used Kaplan-Meier survival analysis to analyze univariate factors that might affect patients’recurrence risk,such as age,T stage,N stage,degree of differentiation,radiotherapy,and patients’general conditions,and used Cox proportional risk model to perform multivariate analysis for the factors with statistically significant differences above.Used theχ²test to analyze age,T staging,N staging,degree of differentiation,depth of surgical resection,blood loss,and general patient conditions those may affect Postoperative bleeding,intraoperative electrocoagulation hemostasis and prophylactic tracheotomy.Binary Logistic regression was used to conduct multivariate analysis of the factors with statistical significance.Results:1.T stage and N stage were the main influencing factors of postoperative recurrence risk of patients with glottic carcinoma treated by plasma radiofrequency coblation（P<0.05）.The recurrence risk of T₂was 6.734 times that of T1,and the recurrence risk of T3 was 14.122 times that of T1.The recurrence risk of N1 was 11.959 times that of N0.2.Electrocoagulation and bleeding volume were the main factors affecting postoperative bleeding,and the difference was statistically significant（P<0.05）.The possibility of postoperative bleeding in patients without electrocoagulation was 8.1%higher than that in patients with electrocoagulation.For every additional 1ml of blood loss,the possibility of postoperative bleeding increased by 7.3%.3.T stage,surgical resection depth and bleeding volume were the main factors to determine whether electrocoagulation hemostasis was performed,and the difference was statistically significant（P<0.05）.The hemostasis probability of T2 is 10.394 times of T1.The possibility of hemostasis by electrocoagulation increased 2.098 times when the depth of vocal cord resection increased after type III.The possibility of electrocoagulation hemostasis increased by 21.3%for every additional 1ml of blood loss.4.T stage,surgical resection depth and blood loss were the main factors to determine whether the patients had preventive tracheotomy,and the difference was statistically significant（P<0.05）.The probability of prophylactic tracheotomy increased 3.127times with each higher T stage.The possibility of prophylactic tracheotomy increased1.342 times with the increase of surgical depth after type III.For every additional 1ml of blood loss,the possibility of preventive tracheotomy increased by 11.1%.Conclusion:1.The later T stage and N stage of glottic carcinoma,the higher the possibility of recurrence after low-temperature plasma radiofrequency coblation.2.When the T stage of glottic carcinoma is late,the resection range is large,the depth is deep and the amount of bleeding is large,electrocoagulation hemostasis should be used during the operation;for the patients who may have secondary bleeding after the operation,preventive tracheotomy should be performed.