Objective:To observe the clinical effect of placing heterogeneous acellular dermal matrix membrane for laryngeal cavity wound healing after CO2 laser Type-Ⅴa cordectomy for glottic carcinoma. Methods:Thirty-five patients with bilateral vocal cord laryngeal cancer who underwent endoscopic CO2 laser surgery at the Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya Hospital of Central South University from March 2018 to December 2019 were selected and divided into 2 groups, including 18 patients in the study group and 17 patients in the control group. The control group was simply placed silicone tube stent, while in the study group, heterogeneous acellular dermal matrix membrane was coated with silicone tube stent. The postoperative laryngeal wound repair and clinical manifestations were observed and compared between the two groups. Results:Compared postoperative laryngeal wound after 6 months: no patients in the study group had granulation tissue, whereas 4 patients in the control group had granulation tissue; 3 patients in the study group developed moderate to severe tissue adhesion, while 9 patients in the control group; 10 patients in the control group developed 2nd to 4th degree laryngeal obstruction, compared with only 4 patients in the study group. Conclusion:The primary placement of ADM can reduce laryngeal granulation tissue and tissue adhesion after CO2 laser Type-Ⅴa cordectomy for laryngeal cancer, and may reduce the occurrence of postoperative laryngeal obstruction.
目的：观察异种脱细胞真皮基质（acellular dermal matrix, ADM）修复膜植入对声门型喉癌CO2激光Ⅴa型声带切除术后喉腔创面修复的临床疗效。 方法：选择2018年3月-2019年12月在中南大学湘雅二医院耳鼻咽喉头颈外科接受内镜下CO2激光手术的35例双侧声带病变喉癌患者为研究对象并分为2组，其中研究组18例，对照组17例，对照组单纯植入硅胶管喉模支架，研究组则在硅胶管外衬ADM，观察2组患者术后喉腔创面的修复情况及相关临床表现。 结果：术后6个月喉腔创面比较，研究组均无肉芽组织残留，对照组4例患者有肉芽残留；研究组3例患者出现中重度喉粘连，对照组9例患者出现中重度喉粘连；对照组10例患者表现为2～4度喉梗阻，研究组仅4例出现相同情况。 结论：ADM Ⅰ期植入不仅能够减少喉癌CO2激光Ⅴa型声带切除术后喉腔肉芽、喉粘连，还可能减少术后喉梗阻的发生。.

Objective:To explore efficacy of narrow band imaging（NBI） technique in CO2laser therapy in Early-Stage Glottic cancer. Methods:The clinical data of patients with Early-Stage Glottic cancer who underwent CO2laser vocal cord resection from June 2011 to August 2022 were retrospectively analyzed. Among these, 27 patients who underwent surgery assisted by NBI were assigned to the observation group, while 25 patients who underwent conventional CO2 laser microsurgery with a suspension laryngoscope were assigned to the control group. The differences between the two groups were analyzed in terms of intraoperative frozen pathology results, postoperative recurrence rates, 5-year cumulative disease-free survival rates, complications, and voice recovery. Results:All 52 patients were operated successfully. Temporary tracheostomy and serious complications did not occur during the operation. The postoperative patient\'s pronunciation was satisfactory. One patient experienced vocal cord adhesion, but there were no severe complications such as breathing difficulties or bleeding, with an overall complication rate of 1.92%. Postoperative follow-up was 1-5 years. The 5 years recurrence free survival in the general group was 77.90％, and the 5 years recurrence free survival in the NBI group was 100％, the difference was statistically significant（P<0.05）. NBI endoscopy is safer and more accurate than the general group in determining the safe margin of tumor mucosal resection（P<0.05）. Among the patients who accepted the voice analysis, the difference was no statistically significant（P>0.05）. Conclusion:Compared with conventional CO2laser surgery under microscope, NBI guided laser resection of Early-Stage Glottic cancer is more accurate. NBI guided laser resection could improve 5 years recurrence free survival rate. In a word, narrow-band imaging endoscopy can has very high value in clinical application.
目的：探讨利用窄带成像技术（narrow band imaging，NBI）术前术后辅助显微支撑喉镜下CO2激光手术进行诊治的早期（T1和T2期）声门型喉癌的临床疗效。 方法：回顾性分析2011年6月1日至2022年8月31日在天津市人民医院耳鼻咽喉头颈外科接受显微支撑喉镜下CO2激光手术治疗的52例早期声门型喉癌患者资料，应用NBI辅助手术的27例患者为观察组，常规支撑喉镜下CO2激光显微手术的25例患者为对照组，随访时间1～5年，总结分析2组患者术中冰冻病理结果、术后复发率、5年累积无复发生存率、并发症及嗓音恢复情况之间的差别。 结果：52例患者均手术顺利，均无需行气管切开术，有1例患者出现声带粘连，但未出现呼吸困难及出血等严重并发症，并发症总发生率为1.92%。观察组5年累积无复发生存率为100％，对照组5年累积无复发生存率为77.90％，2组之间差异有统计学意义（P<0.05）。观察组较对照组的手术切缘更安全，更能准确判断肿瘤黏膜安全切缘（P<0.05）。所有患者进行了嗓音评估，嗓音障碍指数2组之间进行比较，差异无统计学意义（P>0.05）。 结论：与常规支撑喉镜下CO2激光显微手术比较，NBI辅助下显微支撑喉镜下CO2激光手术切除早期声门型喉癌术后复发率低，并发症少，可有效提高5年无复发生存率，是一种更安全有效的治疗方法。.