585-NM pulsed dye laser treatment of glottal dysplasia
585-NM pulsed dye laser treatment of glottal dysplasia
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DOI：
10.1177/000348940311200902
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发表时间：
2003-09-01
影响因子：
1.4
通讯作者：
Anderson, RR
中科院分区：
文献类型：
--
作者：
Franco, RA;Zeitels, SM;Anderson, RR
声门发育不良的管理可能是困难的，往往导致次优的治疗结果。外科医生和患者必须合作平衡关于可能的恶性肿瘤、发声功能障碍和导致多次使用全身麻醉剂的复发的影响的决定。对57例（36例患者和97个声带）无并发症的患者进行了初步研究，以评价585 nm脉冲染料激光（PDL; 450 μ s脉宽，19 - 76 J/cm（2）能量密度，1- 2 mm光斑大小）治疗声带角化病的有效性。57例病例中有40例接受了双侧治疗。57例PDL治疗后35例行显微手术切除。其中增生10例，不典型增生21例，原位癌4例，癌1例。1例患者在PDL治疗前进行了声音显微手术切除。在57例病例中，21例未切除（4例单侧病变和17例双侧病变）进行了放射治疗。该系列中约80%的患者在使用PDL后病变尺寸缩小超过70%，无论是否接受切除术。临床观察显示，尽管57例患者中有28例进行了双侧前连合治疗，但未形成新的前连合网。PDL通过改善止血和在基底膜和下层浅表固有层之间创建最佳剥离平面来增强上皮切除。在这项初步试验中，PDL为声门发育不良提供了相对安全有效的治疗。复发模式的分析将需要更长的随访时间。
Management of glottal dysplasia can be difficult and often results in a suboptimal treatment outcome. The surgeon and patient must cooperatively balance decisions regarding the effects of possible malignancy, vocal dysfunction, and recurrences leading to multiple use of general anesthetics. A pilot study was done in 57 cases (36 patients and 97 vocal folds) without complication to evaluate the effectiveness of a 585-nm pulsed dye laser (PDL; 450-mus pulse width, 19 to 76-J/cm(2) fluence, 1- to 2-mm spot size) in the treatment of vocal fold keratosis. Forty of the 57 cases had bilateral treatment. Phonomicrosurgical resection was done in 35 of the 57 cases after PDL treatment. Of this group, 10 cases were found to have hyperplasia, 21 dysplasia, 4 carcinoma in situ, and 1 carcinoma. One patient had phonomicrosurgical resection before PDL treatment. In 21 of the 57 cases, the disease was irradiated without resection (4 unilateral lesions and 17 bilateral lesions). Approximately 80% of the patients in this series had a greater than 70% reduction in the size of the lesion with the use of the PDL irrespective of whether they underwent resection. Clinical observation revealed no new anterior commissure web formation despite bilateral anterior commissure treatment in 28 of the 57 cases. The PDL enhanced the epithelial excision by improving hemostasis and by creating an optimal dissection plane between the basement membrane and the underlying superficial lamina propria. In this initial trial, the PDL provided relatively safe and effective treatment for glottal dysplasia. Analysis of patterns of recurrence will require longer follow-up.