Analysis Of Related Factors Of Vocal Cord Adhesion After CO₂ Laser Cordectomy

Purpose:To explore and research the related factors of vocal cord adhesion after CO2 laser cordectomy in the laryngeal precancerous lesions and early glottic laryngeal carcinoma.Hope to provide some reference to prevent postoperative vocal cord adhesions.Methods:A total of 103 patients with laryngeal lesions undergoing CO2 laser cordectomy under suspension laryngoscopy were selected,and collect their medical information and postoperative follow-up data.The correlation analysis between sex,diabetes,smoking,alcohol consumption,postoperative vocal cord granulation,surgical scope and depth,Surgical wound of anterior commissure and contralateral vocal cord,laser output power and postoperative vocal cord adhesion were performed.Results:1.Among the 103 patients,49 cases were laryngeal precancerous lesions with an average age of 51.98 and a median age of 55,such as leukoplakia of vocal cord,laryngeal keratosis,atypical hyperplasia and so on.4 cases occured adhesions(8.16%).2 patients with vocal cord adhesion were adult laryngeal papilloma,who had several times of surgical history.54 cases were laryngeal carcinoma with an average age of 62.75and a median age of 62(Tis 2 cases,T1a 20 cases,T1b 29 cases and T2 3 cases).28 cases occured adhesions(51.85%).2 cases relapsed.2.There was no significant difference in the correlation between sex,diabetes mellitus,smoking,alcohol consumption and postoperative vocal cord adhesions(P>0.05),and it was not supported that the factors were related to postoperative vocal cord adhesions.3.35 cases occured granulation tissue formation in the anterior part of the vocal cords,of which 28 cases were vocal cord adhesions.68 cases had no granulation in the anterior part of the vocal cords,of which 4 cases occured vocal cord adhesions.The Chi-square test showed the difference was statistically significant(P<0.001).Cases,which occured granulation tissue formation in the anterior part of the vocal cords,are more likely to cause vocal cord adhesions.4.2 of 44 cases of I-type cordectomy showed adhesions.4 cases of ?-type cordectomy showed no adhesions.4 of 14 cases of ?-type cordectomy showed adhesions.2 cases of ?-type cordectomy showed no adhesions.20 of 31 cases of?-type cordectomy showed adhesions.6 of 8 cases of ?-type cordectomy showed adhesions.The Chi-square test showed the difference was statistically significant(P<0.001).The greater and the deeper of the surgery,the greater the possibility of vocal cord adhesion.5.23 of 32 cases with surgical wound of anterior commissure and contralateral vocal cord showed adhesions.9 of 71 cases without surgical wound of anterior commissure and contralateral vocal cord showed adhesions.The Chi-square test showed the difference was statistically significant(P<0.001).Cases with surgical wound of anterior commissure and contralateral vocal cord are more likely to form adhesions.6.3 of 44 cases with laser output power of 3 or 4W showed adhesions.29 of 59 cases with laser output power of 5W or 6W showed adhesions.The Chi-square test showed the difference was statistically significant(P<0.001).The higher the laser output power,the greater the possibility of postoperative vocal cord adhesion.Conclusion1.The vocal cord adhesions after TLC are related to granulation tissue formation,the surgical scope,the depth,surgical wound of anterior commissure and contralateral vocal cord,and laser output power.TLC in the treatment of squamous cell carcinoma of the anterior commissure of the larynx shows high rate of vocal cord adhesions(71.8%)and severe adhesions.TLC is not recommended.2.The prevention of the vocal cord adhesions is important.Be familiar with the knowledge of medical laser,the indications of laser resection,the parameters of a certain type of laser system,such as laser output power,spot size,mode and so on.Under the specific circumstances of the lesion,accurately choose parameters.Preoperative and intraoperative careful observation of the lesion,assess the depth of infiltration,as far as possible to retain the vocal cord muscle.More follow-up.patients,high-risk of adhesion,must develop a more closely follow-up,and the first laryngoscopic follow-up should be arranged 2 weeks after TLC.For the patients whose vocal cords have granulation tissue or adhesions,if the pronunciation or respiratory function of patients had no significant influence,they can be followed up.Otherwise they should be treated as soon as possible,such as atomizing therapy?endoscopic removal of granulation tissue.