To investigate the clinical efficacy of supported microlaryngoscopic homemade electrodissection for vocal hilar laryngeal cancer. Methods We retrospectively analyzed 20 cases of vocal hilar laryngeal carcinoma treated by supported microlaryngoscopic electrodesis in our department from March 1998 to August 2009, with a follow-up of 12 to 144 months after surgery. The rest of the patients had a vocal fold scar that resembled the vocal fold in shape and appearance, and the articulatory function was significantly better than that of our laryngeal split vocal fold partial excision or laryngeal vertical partial excision. Conclusion The clinical efficacy of microlaryngoscopic support for homemade electrodebrider resection for vocal fold laryngeal cancer is better than that of general partial laryngeal resection and can achieve the efficacy of microlaryngeal laser surgery.
1.Materials and methods
Twenty patients, all male, aged from 48 to 75 years old, with an average age of 66.4 years, were of the vocal hilar type. The pathological diagnosis was squamous cell carcinoma,
Among them, 7 cases were highly differentiated, 11 cases were moderately differentiated and 2 cases were hypofractionated. According to the second revision of the fourth edition of the UICC TNM classification criteria (1992), there were one case of carcinoma in situ (Tia), seven cases of T1a lesions, nine cases of T1b lesions, and three cases of T2 lesions.
The patient was placed in a supine position with a slight shoulder pad and head tilted back, and the patient was intubated through the oral trachea with an anesthetic tube of 6.0-6.5 mm inner diameter. After successful general anesthesia, the laryngoscope was used to fully expose the vocal canal, preferably with a large laryngoscope or a special laryngoscope with larger diameter, and after the tumor was completely seen, a single large saline cotton ball was filled under the microscope to protect the air sac under the vocal canal, and then the tumor was carefully clamped between the tumor and normal tissues with a laryngeal forceps, and the tumor was removed along the outer edge of the tumor at 2-3 mm with a homemade long-handled electric knife.
In this group, there were 2 cases of 2/3 resection of one vocal cord, 3 cases of one vocal cord resection, 6 cases of one vocal cord plus ipsilateral partial vocal cord resection, 4 cases of partial resection of one vocal cord plus anterior colectomy and 1/3 resection of the opposite vocal cord, 3 cases of partial resection of one vocal cord plus partial anterior colectomy, 1 case of partial resection of one vocal cord plus arytenoidectomy, and 1 case of partial resection of one vocal cord plus arytenoidectomy. The wound was not treated after excision. A small amount of the lateral cut edge was taken with laryngeal scissors for rapid sectioning, and more histopathological examination could be performed if the tissue charring was serious.
2, Results
One case of right vocal cord cancer recurred 41 months after resection, and total laryngectomy was performed, and there was no recurrence in five years. There were two cases of choking and coughing after surgery, which disappeared in one week and half a month, respectively.
The scar of the excised vocal folds was close to the original vocal folds in shape and appearance, smaller and thinner than the normal vocal folds. 2 patients with prophylactic tracheotomy were extubated in 3 and 4 days, respectively, and all patients did not undergo radiotherapy. Although we did not do any acoustic test, the pronunciation of the patients was significantly better than that of our partial laryngectomy or vertical partial laryngectomy.
3. Discussion
In the treatment of early laryngeal carcinoma, many experts at home and abroad have tried and compared various surgical procedures and concluded that the 5-year survival rates of radiotherapy and surgery are similar.1 In recent years, due to the popularization of laryngeal microscopy, some hospitals are exploring microsurgery for laryngeal carcinoma of the larynx, so that the lesion can be completely removed with minimal trauma. Microsurgery for larynx includes microscopic laser resection and microscopic laryngeal surgical instruments (surgical instruments are mainly electrodebrider resection), the former requires laser machines, but they are expensive and generally unaffordable for hospitals, and the utilization rate of the machines is not high.
Olsen2 has compared the recurrence rates of these two procedures and concluded that there is no significant difference between the two procedures. The laser has a vaporization zone of about 1mm to 2mm when cutting, while the laser has 4-8 layers of cell structure destruction when cutting the edge of the tissue.3 Visually, it can be seen that the vaporization zone of the tissue is wider than the laser when cutting with the electric knife, and if the unskilled surgeon causes a wider vaporization zone and more layers of cell structure destruction, so the electric cutting is 2mm away from the tumor, Therefore, the actual distance between the electric cut and the tumor may be 4mm or more, and we should take this factor into consideration during surgery, otherwise it will increase unnecessary tissue destruction.
The laser is a linear cut, which requires a certain pulling force on the resected tissues, and the anterior commissurotomy is a triangle, so it is difficult to grasp the depth of the tumor and easy to damage the thyroid cartilage plate in the anterior commissurotomy. In other words, if there is difficulty in cutting, electrocautery can be used, and the depth can be controlled.
In addition, in two cases of vocal cord cancer, the vocal cord was thickened and swollen, blocking the complete exposure of the vocal cord, which made the operation more difficult.
For clinicians with surgical experience, there is not much difference in the degree of damage between microelectrodectomy and microlaser operation, but I believe that the following three elements should be present when using microelectrodectomy for vocal cord cancer surgery.
① The operator should have rich experience in laryngeal cancer resection, especially in partial laryngeal resection, and should be experienced in distinguishing normal tissues from tumor tissues and be very familiar with laryngeal anatomy;
② The operator should know the performance of the electric knife machine and the electric knife head, and use a certain machine and electric knife as much as possible;
③ The microscope should not be too poor, with high clarity, maintaining a certain degree of clarity after magnification, and bright light to facilitate intraoperative visualization of normal and tumor tissue boundaries.
The shortest follow-up period was 12 months and the longest follow-up period was 144 months. None of the patients had laryngeal stenosis, no communication disorder, and clear speech, None of the patients had laryngeal stenosis or difficulty in breathing when walking, which achieved
① Less injury, no neck incision and tracheotomy;
②Low bleeding, the most bleeding in this group was about 20ml, and the field was clear;
③ High accuracy rate and good functional preservation, two patients in this group had heavy hoarseness and the rest had slightly hoarse or near normal voice;
④ Fast healing, small paralysis scar, less infection, low incidence of granulation, and no laryngeal stenosis;
⑤ The average postoperative hospital stay was 6.8 days, and the patient could eat on the same day after surgery;
(6) The total hospitalization time and economic cost were reduced by about 2/3 and 1/2 compared with laryngeal laceration. The total hospital stay and economic cost are reduced by 2/3 and 1/2 compared with laryngectomy. This is a truly economical and minimally invasive procedure.