Laser management of oral leukoplakias: A follow-up study of 70 patients
Laser management of oral leukoplakias: A follow-up study of 70 patients
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DOI：
10.1097/00005537-199906000-00021
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发表时间：
1999-06-01
期刊：
影响因子：
2.6
通讯作者：
Silverman, S
中科院分区：
文献类型：
--
作者：
Schoelch, ML;Sekandari, N;Silverman, S
目的/假设：评估激光治疗口腔癌前病变的疗效。研究设计：研究组由70名连续激光治疗的口腔白斑患者组成。显微镜诊断包括特发性局灶性角化病、所有级别的发育不良和疣状增生（增生性疣状白斑）。39例患者有一定程度的显微镜下发育不良，6例表现为高危增生性疣状白斑。临床表现为白色（均匀性白斑）48例，红白相间（红色白斑）8例，疣状14例。这一组有38名男性和32名女性。平均年龄为63岁（范围，31-90岁）。研究方法：所用激光为CO2和Nd：YAG激光，并使用标准激光安全方案。结果：无术后感染、出血或感觉异常。2例患者手术部位出现化脓性肉芽肿，70例患者中有55例随访6个月以上，平均随访32个月（范围6-178个月），29名患者完全控制了病变; 19名患者通过后续激光手术去除了小复发，从而得到控制; 2名患者完全复发; 5例患者在病变部位发生鳞状细胞癌，疣状病变的复发率特别高（83%），其中9例最终通过后续手术得到控制。结论：口腔白斑的激光手术是一种有效的工具，在一个完整的管理策略，包括仔细的临床随访，患者教育，以消除危险因素和报告可疑病变，并在适当的可疑病变活检。然而，癌症复发和进展仍然是一种风险。
Objectives/Hypothesis: To assess the efficacy of laser therapy for the management of premalignant oral lesions. Study Design: The study group consisted of seventy consecutive laser-treated patients with oral leukoplakia. The microscopic diagnosis included idiopathic focal keratosis, dysplasias of all grades, and verrucous hyperplasia (proliferative verrucous leukoplakia). Thirty-nine patients had some degree of microscopic dysplasia and six demonstrated highrisk proliferative verrucous leukoplakia. The clinical appearances of the lesions were white (homogeneous leukoplakia) in 48, red and white (erythroleukoplakia) in 8, and verrucous in 14. There were 38 men and 32 women in this group. The average age was 63 years (range, 31-90 y). Methods: Lasers employed were the CO2 and Nd:YAG lasers, and standard laser safety protocols were used, Results: There was no postoperative infection, hemorrhage, or paresthesia. Two patients developed pyogenic granulomas in their surgical sites, Fifty-five of 70 patients were followed for more than 6 months; follow-up averaged 32 months (range 6-178 mo), Twenty-nine patients had complete control of their lesions; 19 patients had small recurrences removed with subsequent laser surgeries, leading to control; 2 patients had complete recurrences; and 5 patients developed squamous cell carcinoma at the lesion site, Verrucous lesions had an especially high rate of recurrence (83%), with 9 of 12 ultimately controlled with subsequent surgeries. Conclusions: Laser surgery of oral leukoplakia is an effective tool in a complete management strategy that includes careful clinical follow-up, patient education to eliminate risk factors and report suspicious lesions, and biopsy of suspicious lesions when appropriate. How ever, recurrence and progression to cancer remain a risk.