Feasibility of transnasal flexible carbon dioxide laser surgery for laryngopharyngeal lesions
Feasibility of transnasal flexible carbon dioxide laser surgery for laryngopharyngeal lesions
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DOI：
10.1016/j.anl.2019.01.008
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发表时间：
2019-10-01
影响因子：
1.7
通讯作者：
Shiotani, Akihiro
中科院分区：
文献类型：
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作者：
Araki, Koji;Tomifuji, Masayuki;Shiotani, Akihiro
目的：光纤引导二氧化碳(CO2)激光器是一种实用的喉咽外科手术设备。柔性CO2波导激光器已经开发出来并投入商业使用已有数年之久。然而，在日本，通过柔性内窥镜的器械通道(CO2 TNFLS)经鼻使用CO2柔性波导激光手术是不被允许的。这项可行性研究旨在评估办公室二氧化碳TNFLS手术的价值和安全性。方法：从2015年6月开始纳入喉咽小疾病患者。符合条件的患者有病变一般局限于浅表病变的适应证，如良性肿瘤、白斑和癌前病变样原位癌(CIS)。患者使用羟氯卡因局部麻醉良好。结果：18例患者共13例，其中乳头状瘤9例，其中复发性呼吸道乳头状瘤7例，原位癌2例，白斑1例，大型会厌囊肿1例。4名RRP患者需要进行多次手术。除3例RRP外，所有患者均获得疾病控制，无需额外干预。所有手术均顺利完成，无严重不良事件发生。结论：以办公室为基础的CO2 TNFLS对咽喉部病变患者是安全可行的。对于病变较小的RRP患者，避免在全身麻醉下手术尤其有价值。(C)2019爱思唯尔B.V.保留所有权利。
Objective: The fiber-guided carbon dioxide (CO2) laser is a useful device for laryngopharyngeal surgery. The flexible CO2 wave-guide laser has been developed and commercially available for several years. However, the transnasal use of CO2 flexible wave-guided laser surgery through the instrument channel of a flexible endoscope (CO2 TNFLS) is not permitted in Japan. This feasibility study aimed to assess the value and the safety of an in-office CO2 TNFLS procedure.Methods: Patients with small laryngopharyngeal diseases were enrolled from June 2015. Eligible patients had indications with lesions generally localized superficial lesions such as the benign tumor, leukoplakia, and premalignant lesion-like carcinoma in situ (CIS). Patients were locally well anesthetized using xylocaine. After removing as much of the lesion(s) as possible with flexible forceps, the remainder of the lesions were evaporated using CO2 TNFLS through the instrument channel of a flexible endoscope under local anesthesia.Results: Eighteen surgeries involving 13 patients, including 9 papilloma (7 recurrent respiratory papilloma [RRP]), 2 carcinoma in situ, 1 leukoplakia, and 1 large epiglottic cyst), were performed. Four patients with RRP required multiple surgeries. Except for 3 patients with RRP, all patients achieved disease control without additional intervention. All procedures were completed with no severe adverse events.Conclusion: Office-based CO2 TNFLS is safe and feasible for patients with laryngopharyngeal pathologies. It is especially valuable for RRP patients with small lesions to avoid surgery under general anesthesia. (C) 2019 Elsevier B.V. All rights reserved.