Clinical Application And Research Of CO₂ Laser In Laryngeal Precancerous Lesions And Early Glottic Carcinoma

Objective:To investigate the clinical application of CO₂ laser in the treatment of laryngeal precancerous lesions and early glottic carcinoma,observe the clinical efficacy,summarize the treatment experience and provide reference for clinical treatment.Methods:Clinical data of 111 patients who received CO₂ laser surgery in the Department of Otolaryngology and Head and Neck Surgery,the First Hospital of Shanxi Medical University from January 2017 to July 2020 and were diagnosed with laryngeal precancerous lesions and early glottic carcinoma were retrospectively analyzed.There were 41 cases of laryngeal precancerous lesions（14 cases of adult laryngeal papilloma,5cases of vocal cord leukoma,22 cases of atypical hyperplasia）and 70 cases of early glottic carcinoma（23 cases of Tis,19 cases of T1a,14 cases of T1b,14 cases of T2）.The curative effect was evaluated by surgical complications and postoperative recurrence rate,the influencing factors of postoperative recurrence in early glottic carcinoma were further analyzed.And the mucosal recovery after CO₂ laser treatment was observed.Results:（1）All patients were followed up for 7-48 months,with the median follow-up time was 20 months and a mean follow-up time of 22±12 months.There was no death in 111patients.（2）The most common postoperative complications were vocal cord adhesion,other complications included granuloma,tongue compression,cough and so on.（3）The postoperative recurrence rate of laryngeal precancerous lesions was 9.8%,and the canceration rate was 4.8%.One adult laryngeal papilloma received prophylactic tracheotomy and was successfully extubated before discharge.（4）The postoperative recurrence rate of early glottic carcinoma was 11.4%（8/70）,the single factor analysis found that the recurrence rate of the difference gender,difference age,smoking,drinking,and anterior commissure lesion has no statistical significance（P>0.05）;Type of operations and T staging of tumor have differences between groups,statistically significant（P<0.05）,multi-factor analysis found that T stage of tumor was the independent risk factors of postoperative recurrence.The postoperative recurrence rate was statistically significant in the surgical method and tumor T stage（P=0.040,P=0.035）.Multivariate Logistic regression showed that T2 stage was an independent risk factor for postoperative recurrence after CO₂ laser surgery（OR=12.222,95%CI 1.247-119.828,P=0.032）.（5）With a mucosa defect postoperative scar and compare the difference was statistically significant between surgery（P<0.001）,Ⅳ,Ⅴpatients thanⅠ,Ⅱpatients are more likely to appear mucosal defect and scar after surgery.Conclusion:（1）For the treatment of laryngeal precancerous lesions and early glottic carcinoma,CO₂ laser is a safe and effective treatment,and it can also be used as a salvage treatment for postoperative recurrence.（2）The postoperative recurrence rate of early glottic carcinoma was related to the surgical method and tumor T stage,and T2 stage was an independent risk factor for postoperative recurrence of patients after surgery.The involvement of anterior combination was not related to postoperative recurrence after CO₂ laser surgery.（3）The condition of mucosal repair after CO₂ laser surgery is related to the surgical method,so preoperative lesion range should be accurately judged and surgical indications should be strictly grasped.