The Retrospective Study Of The Early Glottic Carcinoma Treated By The Diomed-25 Semiconductor Laser And Relative Basic Research

The retrospective study and relative experimental study of the early glottic carcinoma treated by the Diomed-25 semiconductor laser We explored 18 cases suffering from the early glottic carcinoma treated by the Diomed-25 semiconductor laser from the conception and diagnosis , compared the laser surgery with the partial laryngectomy from the effect, the hospitalization, the preservation of laryngeal function and the voice acoustics, and found some advantages of laser surgery: (1) To save the surgery time and money; (2) To avoid the possible tracheotomy and keep the laryngeal cartilages complete; (3) To preserve the laryngeal function; (4) the voice acoustics of the laser group is better than that of the partial laryngectomy group; (5)the laser surgery can be completed in local anesthesia. However laser surgery also has some limitations: Some carcinoma which near the anterior of vocal cord and the anterior commissure under self-sustaining laryngoscope can't be exposed completely, which often lead to the high recurrent rate. The laryngeal carcinoma, which invaded the anterior commissure, is considered as the contraindication of CO2 laser surgery by some scholars. The reason is that the distance between the anterior commissure and the thyroid cartilage is only 2-3mm and it is difficult to get safety range when the carcinoma invaded the anterior commissue. The recurrent rate of T2 is also higher. We explored two parts in 4PDF 文件使用 "pdfFactory Pro" 试用版本创建 www.fineprint.com.cn第二军医大学博士论文 the animal experiment. Part one: the recovery study of excising the different range of dog's anterior commissure by semiconductor laser. 12 dogs were divided into 3 groups randomly. In group A, the excised range including the anterior , the thyroid cartilage's inner-membrane of the anterior commissure, the right vocal cord , and 1/3 of the left vocal cord. In group B, part of the thyroid cartilage of the anterior commissure besides the range of A were cauterized. In group C, the fenestration about 5mm x 5mm was done on the thyroid cartilage of the anterior commissure besides the range of group B was cauterized. We found the recovery of wounds had no obvious differences between the 3 groups in the long term (more than 4 weeks). Completely membranous blocked the window on the thyroid cartilage. The observation of larynx had no distinct differences between the three groups. There were no obvious complications in each group. The results tell us that we can excise not only the space 2-3mm between the anterior commissure and the thyroid cartilage but also part of the thyroid cartilage. Even the cervical tenioid muscles can be reached by fenestration. The test bring us new idea that the framework of larynx may be broken to get the satisfied safety range and reduce the recurrence rate. Part two: the observation of different excised range of vertical hemilaryngectomy by semiconductor laser. 12 dogs were divided into 3 groups randomly. We imitated the whole process of vertical hemilaryngectomy under self-sustaining laryngoscope by laser. The repairing of wounds was good after surgery. In group A, there 5PDF 文件使用 "pdfFactory Pro" 试用版本创建 www.fineprint.com.cn第二军医大学博士论文 were new tissues replaced the anterior commissure and the right vocal cord. The surface was smooth. There was only a slit when the glottis closed. In group B, the right vocal cord was narrower and thinner than the left and the surface was smooth. The granulation can be seen sometimes. The glottis could not be closed completely. In group C, there were dark red neonatal membranes covered the surface and there were no infection like exudation. The vocal cord swelled a little and the glottis could not closed seriously. The operative l...