PDF(Pubmed)
Abstract：
OBJECTIVE: The current research was designed to compare the clinical efficacy of suspension laryngoscopic mucosal dissection and plasma resection in the management of laryngeal leukoplakia and their effects on patient prognosis.
METHODS: Retrospective analysis was conducted on 184 laryngeal leukoplakia patients treated in Ningbo Beilun People\'s Hospital from January 2018 to October 2021. Based on the inclusion and exclusion criteria, 128 eligible patients were included, including 64 patients who underwent suspension laryngoscopic mucosal dissection (control group) and 64 patients who underwent cryolyrectomy (study group). The operative time, intraoperative bleeding volume, and time of pseudomembrane detachment in the two groups were recorded. Enzyme-linked immunosorbent assay (ELISA) was used to determine the serum concentrations of interleukin (IL)-2, IL-4, IL-6, IL-10, tumor necrosis factor (TNF)-α, interferon-γ (IFN-γ), and IL-17A at 24 hours after surgery. Postoperative follow-up was conducted for one year. Results of the noise acoustic testing and stroboscopic laryngoscopy, including noise/harmonic ratio, amplitude perturbation, fundamental frequency perturbation, vocal fold vibration symmetry, and vocal fold mucosal wave, were documented before treatment and three months after treatment. The cumulative recurrence rate of patients within one year after surgery was recorded, and the cumulative recurrence rate of patients within 1 year after surgery was compared between the two groups.
RESULTS: Cryo-plasma resection significantly contributed to shorter operative time and less intraoperative bleeding volume as compared with suspension laryngoscopic mucosal dissection (both P<0.05), while time-lapse before postoperative pseudomembrane detachment was similar between the two groups (P>0.05). Patients with cryo-plasma resection exhibited significantly milder postoperative inflammatory response than those with suspension laryngoscopic mucosal dissection, as evinced by the lower serum concentrations of IL-2, IL-6, TNF-α, IFN-γ and IL-17A at 24-h in patients with cryo-plasma resection after operation (P<0.05), while the levels of IL-4 and IL-10 were similar between the two groups (P>0.05). At 3 months after operation, cryo-plasma resection contributed to more significant reductions of noise/harmonic ratio, amplitude perturbation, fundamental frequency perturbation, vocal fold vibration symmetry, and vocal fold mucosal as compared with suspension laryngoscopic mucosal dissection (P<0.05). Cryo-plasma resection contributed to a significantly lower incidence of cumulative recurrence than suspension laryngoscopic mucosal dissection (P<0.05). Multivariate analysis revealed no statistical difference in the impact of gender, age, smoking, and alcohol consumption on the recurrence and malignant transformation of laryngeal leukoplakia (P>0.05).
CONCLUSIONS: Both suspension laryngoscopic mucosal dissection and plasma resection can provide significant efficacy in the treatment of laryngeal leukoplakia, and cryo-plasma resection can contribute to a lower incidence of relapse, enhanced postoperative recovery, and superior short- and long-term outcomes than plasma resection.
METHODS: Retrospective analysis was conducted on 184 laryngeal leukoplakia patients treated in Ningbo Beilun People\'s Hospital from January 2018 to October 2021. Based on the inclusion and exclusion criteria, 128 eligible patients were included, including 64 patients who underwent suspension laryngoscopic mucosal dissection (control group) and 64 patients who underwent cryolyrectomy (study group). The operative time, intraoperative bleeding volume, and time of pseudomembrane detachment in the two groups were recorded. Enzyme-linked immunosorbent assay (ELISA) was used to determine the serum concentrations of interleukin (IL)-2, IL-4, IL-6, IL-10, tumor necrosis factor (TNF)-α, interferon-γ (IFN-γ), and IL-17A at 24 hours after surgery. Postoperative follow-up was conducted for one year. Results of the noise acoustic testing and stroboscopic laryngoscopy, including noise/harmonic ratio, amplitude perturbation, fundamental frequency perturbation, vocal fold vibration symmetry, and vocal fold mucosal wave, were documented before treatment and three months after treatment. The cumulative recurrence rate of patients within one year after surgery was recorded, and the cumulative recurrence rate of patients within 1 year after surgery was compared between the two groups.
RESULTS: Cryo-plasma resection significantly contributed to shorter operative time and less intraoperative bleeding volume as compared with suspension laryngoscopic mucosal dissection (both P<0.05), while time-lapse before postoperative pseudomembrane detachment was similar between the two groups (P>0.05). Patients with cryo-plasma resection exhibited significantly milder postoperative inflammatory response than those with suspension laryngoscopic mucosal dissection, as evinced by the lower serum concentrations of IL-2, IL-6, TNF-α, IFN-γ and IL-17A at 24-h in patients with cryo-plasma resection after operation (P<0.05), while the levels of IL-4 and IL-10 were similar between the two groups (P>0.05). At 3 months after operation, cryo-plasma resection contributed to more significant reductions of noise/harmonic ratio, amplitude perturbation, fundamental frequency perturbation, vocal fold vibration symmetry, and vocal fold mucosal as compared with suspension laryngoscopic mucosal dissection (P<0.05). Cryo-plasma resection contributed to a significantly lower incidence of cumulative recurrence than suspension laryngoscopic mucosal dissection (P<0.05). Multivariate analysis revealed no statistical difference in the impact of gender, age, smoking, and alcohol consumption on the recurrence and malignant transformation of laryngeal leukoplakia (P>0.05).
CONCLUSIONS: Both suspension laryngoscopic mucosal dissection and plasma resection can provide significant efficacy in the treatment of laryngeal leukoplakia, and cryo-plasma resection can contribute to a lower incidence of relapse, enhanced postoperative recovery, and superior short- and long-term outcomes than plasma resection.
摘要：
目的：本研究旨在比较喉镜下黏膜剥离术和等离子切除术治疗喉白斑的临床疗效及其对患者预后的影响。
方法：回顾性分析2018年1月至2021年10月宁波市北仑人民医院收治的184例喉白斑患者的临床资料。根据纳入和排除标准，包括128名符合条件的患者，包括64例接受喉镜下黏膜剥离术的患者（对照组）和64例接受冷冻切除术的患者（研究组）。手术时间,术中出血量,记录两组假膜脱离时间。酶联免疫吸附试验(ELISA)测定血清白细胞介素(IL)-2、IL-4、IL-6、IL-10、肿瘤坏死因子(TNF)-α、干扰素-γ（IFN-γ），和IL-17A在手术后24小时。术后随访一年。噪声声学测试和频闪喉镜检查的结果，包括噪声/谐波比，振幅扰动，基频扰动，声带振动对称，声带粘膜波，在治疗前和治疗后三个月记录。记录患者术后1年内的累积复发率,比较两组患者术后1年内的累计复发率。
结果：与支撑喉镜黏膜剥离术相比，低温等离子切除术可显著缩短手术时间和减少术中出血量（均P<0.05）。两组术后假膜脱离前的时间相似（P>0.05）。低温等离子切除术患者的术后炎症反应明显低于悬吊喉镜黏膜剥离术患者。如IL-2，IL-6，TNF-α的血清浓度较低，IFN-γ和IL-17A在术后24h时的表达(P<0.05),两组IL-4和IL-10水平差异无统计学意义(P>0.05)。术后3个月，低温等离子切除有助于更显著地降低噪声/谐波比，振幅扰动，基频扰动，声带振动对称，声带粘膜与悬吊喉镜粘膜剥离术比较(P<0.05)。低温等离子切除术的累积复发率明显低于支撑喉镜黏膜剥离术（P<0.05）。多因素分析显示性别影响无统计学差异，年龄,吸烟,饮酒对喉白斑复发及恶变的影响(P>0.05)。
结论：喉镜下黏膜剥离术和等离子切除术均可有效治疗喉白斑。低温等离子切除术可以降低复发率，增强术后恢复，且短期和长期结局优于血浆切除术。
方法：回顾性分析2018年1月至2021年10月宁波市北仑人民医院收治的184例喉白斑患者的临床资料。根据纳入和排除标准，包括128名符合条件的患者，包括64例接受喉镜下黏膜剥离术的患者（对照组）和64例接受冷冻切除术的患者（研究组）。手术时间,术中出血量,记录两组假膜脱离时间。酶联免疫吸附试验(ELISA)测定血清白细胞介素(IL)-2、IL-4、IL-6、IL-10、肿瘤坏死因子(TNF)-α、干扰素-γ（IFN-γ），和IL-17A在手术后24小时。术后随访一年。噪声声学测试和频闪喉镜检查的结果，包括噪声/谐波比，振幅扰动，基频扰动，声带振动对称，声带粘膜波，在治疗前和治疗后三个月记录。记录患者术后1年内的累积复发率,比较两组患者术后1年内的累计复发率。
结果：与支撑喉镜黏膜剥离术相比，低温等离子切除术可显著缩短手术时间和减少术中出血量（均P<0.05）。两组术后假膜脱离前的时间相似（P>0.05）。低温等离子切除术患者的术后炎症反应明显低于悬吊喉镜黏膜剥离术患者。如IL-2，IL-6，TNF-α的血清浓度较低，IFN-γ和IL-17A在术后24h时的表达(P<0.05),两组IL-4和IL-10水平差异无统计学意义(P>0.05)。术后3个月，低温等离子切除有助于更显著地降低噪声/谐波比，振幅扰动，基频扰动，声带振动对称，声带粘膜与悬吊喉镜粘膜剥离术比较(P<0.05)。低温等离子切除术的累积复发率明显低于支撑喉镜黏膜剥离术（P<0.05）。多因素分析显示性别影响无统计学差异，年龄,吸烟,饮酒对喉白斑复发及恶变的影响(P>0.05)。
结论：喉镜下黏膜剥离术和等离子切除术均可有效治疗喉白斑。低温等离子切除术可以降低复发率，增强术后恢复，且短期和长期结局优于血浆切除术。
