Related Factors Analysis Of The Postoperative Vocal Cord Adhsion In CO₂ Laser Surgery For Early Glotic Carcinoma

Objective:To explore the factors realted to postoperative vocal cord adhsion in CO2 laser surgery in early glotic carcinoma. Improve the understanding of iatrogenic vocal cord adhesion, provide the reference for different surgical types in early glottis carcinoma improve quality of postoperative survival of patients.Methods:51 patients performed CO2 laser surgery for early glotic carcinoma from September 2007 to March 2014 were analysed retrospectively. Patients were performed postoperative laryngoscope examination review 1 times a week for 3 months after postoperative 3 months monthly review of laryngoscope examination for 1 year was performed. After preoperative T staging of tumor, whether inflitrated to anterior commisure and presence of granulation, surgery was performed.Results:Among 51 cases,23 cases (45.10%) occurred vocal cord adhesion, all have different degrees of the haorsense of voice, the time interval of occurrence of the adhesion was postoperative 1 week to 6 months, the median time was 2.5 months. Vocal cord surface granulation was found 25 cases. Among 25 cases occurred with vocal coed granulation showed the adhesion, accounting 32%(8/25). The time interval of the occurrence of vocal cord granulation was postoperative 2 weeks to 4 months, the median time was 2 months. The remaining cases did not lead to vocal cord adhesion but also disappeared with in 2 months. Chi-square test showed that vocal coed adhesion, T staging of the tumor and surgical methods showed corelation (P< 0.05), but cannot illustrate the relation between vocal cord adhesiona and infiltration to anterior commisure (P> 0.05).Conclusion:1. Vocal cord adhesion is associated with the area of granulation, any factors that cause excessive fibrous repair can aggravate the vocal cord adhesion. For the granulation on anterior 1/3 of the vocal cords, especially on one the unilateral the vocal cord surface granulation tissue may contact to contralateral the vocal cord or suspected cancerous recurrence, the mass increases progressively. Those granulation which did not disappear with in 2 months should performed early by surgical intervention. Postoperative early electronic laryngoscope follow-up with in 2.5 months assists the early detection of granulation tissue overgrowth. Early surgical intervention is helpful to reduce the occurrence of vocal cord adhesion, improving the quality postoperatives survival.2. Vocal cord adhesion is related to T staging of the tumor and the surgical types, and can’t prove that whether related to anterior commisure inflitration. The choice of operation type was positively correlated with tumor T stage, the higher staging of the tumor, the wider and deeper of the surgical resection range. CO2 laser surgery has greater chance of the occurrence of adhesion.