光纤CO_2激光的可靠性和有效性:39例患者的前瞻性研究  

Reliability and efficacy of a new CO_2 laser hollow fiber:a prospective study of 39 patients

作　　者：Remacle M Ricci-Maccarini A Matar N 江玲燕[2] 

机构地区：[1]不详 [2]首都医科大学附属北京佑安医院耳鼻咽喉头颈外科

出　　处：《中国医学文摘（耳鼻咽喉科学）》2014年第6期338-341,共4页Chinese Medical Digest(Otorhinolaryngology)

摘　　要：第一次报道使用科医人公司的新产品Fiber Lase光纤CO2激光（AcuPulse40WG）行经口咽CO2激光手术的患者，目的是为了检验其可靠性和有效性。患者的入选标准为年龄大于18岁，13腔、咽、喉或气管内有良性或癌前病变，均在签署知情同意书之后纳入研究。这项前瞻性研究于2010年10月～2011年5月在2家三级治疗大学医院中完成。本研究共包含39例患者，平均年龄47．9岁（18～86岁）其中21例女性，18例男性。13例淋巴组织肥大（腭部和，或舌部），9例肉芽肿病变，4例渗出性声带病变，3倒严重的异型增生（声门和声门上），3例黏膜自斑，2例声带囊肿，2例喉乳头状瘤，2例双侧声带麻痹，1例痉挛性发音障碍。82％的手术在全麻联合气管插管下完成。光纤CO2激光插入手具内使用，大多数与外科显微镜联合使用。输送激光的参数为超脉；中或CW模式，平均功率为9W（3～15W），连续曝光。光纤CO2激光耐用程度高，术中无需更换。术中未见光纤CO2激光导致的并发症。8例扁桃体手术使用了双极烧灼术来控制出血。光纤CO2激光是一种安全可靠，简单易用的经口腔激光手术工具。该器械具有足够的耐用性，可以完成整个手术过程，术中无需更换另外的光纤。经口咽光纤CO2激光手术的成功取决于病灶的位置和类型、CO2激光组织效应及手术者的经验。We present the first series of patients treated by transoral laser surgery （TLS） using the new AcuPulse 40WG CO2 laser with the FiberLase flexible waveguide （CO2 LWG） with the objective to test its reliability and efficacy. Patients older than 18 years, with oral, pharyngo-laryngeal or tracheal benign or premalignant lesions were enrolled after signing an informed consent. This prospective study was conducted between October 2010 and May 2011 in two tertiary care university hospitals. Thirty-nine patients were enrolled in the study. The mean age was 47.9 years （range 18-86 years） . There were 21 women and 18 men. Thirteen patients had hypertrophy of lymphoid tissue （palatine and or lingual） , nine patients had granulomas, four patients had an exudative glottic lesion, three patients had severe dysplasia （glottic and supraglottic） , three patients had leukoplakia, two patients had glottal cysts, two patients had laryngeal papilloma, two patients had bilateral paralysis of the vocal folds and one patient suffered from spasmodic dysphonia. Eighty-two percent of the procedures were performed under general anesthesia with laryngo-tracheal intubation. The CO2 iber passed through a handpiece was used with a microscope in the majority of the procedures. The laser delivery mode parameter used was： SuperPulse or Continuous Wave. Power levels were 3~15 W, continuous delivery. Each procedure utilized one CO2 fiber which performed adequately throughout the procedure. No complications were noted with the use of this technology. A bipolar cautery was needed to control bleeding in eight procedures; all these procedures were tonsillectomies. The CO2 LWG is a safe and reliable tool for TLS. It is durable enough to last through the entire surgical procedure without the need for replacement. Its use must be tailored depending on the type and location of the lesion, the CO2 lasers tissue effects as well as the surgeon＇s experience.

关 键 词：喉(Larynx):咽(Pharynx) 光纤CO2激光(CO2 laser wave guide):经口咽喉显微手术(transoral LARYNGEAL microsurgery) 

分 类 号：R197.323[医药卫生—卫生事业管理]