發(fā)布時間：2018-12-14 06:34

【摘要】：目的:總結(jié)低溫等離子微創(chuàng)手術(shù)并一期V型喉硅膠膜置入治療T1、部分T2期聲門型喉癌的術(shù)后臨床恢復情況。方法:回顧我院2013年3月至2015年3月收治的符合入選條件的30例行低溫等離子微創(chuàng)手術(shù)并一期V型喉硅膠膜置入與35例行傳統(tǒng)喉裂開手術(shù)并一期V型喉硅膠膜置入治療早期聲門癌的患者術(shù)后情況并進行統(tǒng)計學分析。結(jié)果:65例病例根據(jù)所采取的手術(shù)術(shù)式分為低溫等離子微創(chuàng)手術(shù)并一期V型喉硅膠膜置入組(研究組)和傳統(tǒng)喉裂開手術(shù)并一期V型喉硅膠膜置入組(對照組),其中研究組30例,對照組35例。研究組30例中后無一例術(shù)后出現(xiàn)呼吸困難;對照組35例中有2例患者出現(xiàn)呼吸困難;兩組呼吸程度的比較不存在統(tǒng)計學差異(P0.05)。研究組30例患者中術(shù)后無明顯疼痛者19例,術(shù)后輕度疼痛者11例,無術(shù)后中、重度疼痛者;對照組35例患者中術(shù)后無明顯疼痛者9例,術(shù)后輕度疼痛者20例,術(shù)后有中度疼痛者6例,無術(shù)后重度疼痛者。兩組患者疼痛程度(NRS評分)比較存在統(tǒng)計學差異(P0.05)。研究組30例患者中術(shù)后檢查隨訪發(fā)現(xiàn)黏膜不光滑者1例;對照組35例患者中術(shù)后檢查隨訪發(fā)現(xiàn)黏膜不光滑者4例。兩組患者術(shù)后黏膜愈合情況比較不存在統(tǒng)計學差異(P0.05)。根據(jù)誤咽分級,研究組30例患者中術(shù)后0級誤咽28例,1級誤咽2例;對照組中35例患者中術(shù)后0級誤咽30例,1級誤咽5例。兩組病例術(shù)后均未出現(xiàn)2級和3級誤咽且兩組病例在吞咽功能的比較上不存在統(tǒng)計學差異(P0.05)。根據(jù)GRBAS嗓音評估系統(tǒng)中的總嘶啞度對兩組患者術(shù)后發(fā)音功能進行評估,研究組30例患者中術(shù)后總嘶啞度評估1級的有23例,2級的6例以及3級的1例;對照組35例患者中術(shù)后總嘶啞度評估1級19例,2級9例以及3級7例。兩組病例在發(fā)音功能的比較上存在統(tǒng)計學差異(P0.05)。結(jié)論:本研究證明低溫等離子微創(chuàng)手術(shù)并一期V型喉硅膠膜置入治療早期聲門型喉癌較傳統(tǒng)喉裂開手術(shù)一期V型喉硅膠膜置入治療早期聲門型喉癌對患者術(shù)后減輕疼痛,發(fā)音功能恢復方面存在優(yōu)勢,而對術(shù)后呼吸功能、吞咽功能及粘膜愈合情況的影響方面兩種術(shù)式效果相當。
[Abstract]:Objective: to summarize the clinical recovery of patients with T 1, T 2 stage glottic laryngeal carcinoma treated by low temperature plasma minimally invasive surgery and one stage V type laryngeal silicone film implantation. Methods: from March 2013 to March 2015, 30 cases of low temperature plasma minimally invasive surgery and one stage V type laryngeal silicone film implantation and 35 cases of traditional laryngotomy and one stage V type laryngeal silicone film placement were retrospectively reviewed in our hospital. The postoperative status of patients with early glottic carcinoma was analyzed statistically. Results: 65 cases were divided into low temperature plasma minimally invasive operation and one stage V type laryngeal silicone film implantation group (study group) and traditional laryngotomy with one stage V type larynx silicone film implantation group (control group). There were 30 cases in the study group and 35 cases in the control group. There was no postoperative dyspnea in 30 cases in the study group and 2 cases in the 35 cases in the control group. There was no significant difference in respiratory degree between the two groups (P0.05). In the study group, there were 19 cases of no obvious postoperative pain, 11 cases of mild postoperative pain, and no postoperative moderate or severe pain. In the control group, 9 cases had no obvious postoperative pain, 20 cases had mild pain, 6 cases had moderate pain, and no severe postoperative pain. The pain degree (NRS score) was significantly different between the two groups (P0.05). In the study group, 1 case was found to have mucosal unsmoothness after operation and 4 cases were found to have mucosal unsmoothness in 35 cases in the control group. There was no statistical difference between the two groups in mucosal healing after operation (P0.05). According to the grade of false pharynx, there were 28 cases in grade 0 and 2 cases in grade 1 in study group, and 30 cases in grade 0 and 5 cases in grade 1 in control group. There were no grade 2 or 3 grade false pharynx in the two groups after operation and there was no statistical difference in the swallowing function between the two groups (P0.05). According to the total hoarseness in the GRBAS voice evaluation system, the postoperative articulation function of the two groups was evaluated. In the study group, 23 patients were evaluated with the total hoarseness of postoperative grade 1, 6 with the second grade and 1 with the third grade in the study group. In the control group, the total hoarseness was evaluated in 19 cases of grade 1, 9 cases of grade 2 and 7 cases of grade 3 after operation. There was statistical difference in pronunciation function between the two groups (P0.05). Conclusion: this study demonstrated that the treatment of early glottic laryngeal carcinoma with low-temperature plasma minimally invasive surgery combined with one-stage V-type laryngeal silicone film implantation was more effective than that of traditional laryngotomy in the treatment of early glottic laryngeal carcinoma. There were advantages in the recovery of articulation function, but the effects on postoperative respiratory function, swallowing function and mucosal healing were similar.
【學位授予單位】：河南科技大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R739.65

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