显微支撑喉镜下CO_(2)激光与等离子射频消融术切除会厌囊肿的临床疗效比较  

Comparison of Clinical Efficacy:CO_(2) Laser vs.Plasma Radiofrequency Abla-tion for Removal of Epiglottic Cysts under Self-Retaining Laryngoscope

作　　者：王竹 李巍 李培华 曹磊 张艳秋[4] WANG Zhu;LI Wei;LI Peihua;CAO Lei;ZHANG Yanqiu(Department of Otolaryngology,Changzhou First People's Hospital,Changzhou 213000,China;Graduate School of Xuzhou Medical University;Department of Otolaryngology,Head and Nech Surgery,Affiliated Hospital of Xuzhou Medical University;Xuzhou Cancer Hospital)

机构地区：[1]常州市第一人民医院耳鼻喉科,常州市213000 [2]徐州医科大学研究生学院 [3]徐州医科大学附属医院耳鼻喉头颈外科 [4]徐州市肿瘤医院

出　　处：《中国激光医学杂志》2023年第1期19-23,58,共6页Chinese Journal of Laser Medicine & Surgery

基　　金：徐州市科学技术局科研课题(KC15SH068)。

摘　　要：目的探讨显微支撑喉镜下CO_(2)激光与等离子射频消融术切除会厌囊肿的临床疗效。方法回顾性分析2019年1月至2020年5月,会厌囊肿患者80例,根据手术方式不同将患者分为观察组和对照组,每组患者各40例,观察组采用显微支撑喉镜下CO_(2)激光显微手术,激光治疗功率4~6W;对照组采用支撑喉镜下等离子射频消融术。记录两组患者手术时间、术中出血。术后1d、3d和7d患者根据自身疼痛程度,采用视觉模拟评分法(visual analogue scale,VAS)评估疼痛程度。比较术后两组患者白膜脱落情况、术后3个月的复发率、不良反应和并发症发生率。结果观察组手术时间(9.35±2.0)min较对照组(6.50±4.4)min长(P<0.05);观察组出血量(1.63±0.9)ml少于对照组(3.20±1.2)ml(P<0.05)。术后7d,观察组白膜基本脱落,脱落时间(7.20±1.2)d,可窥及红润黏膜;对照组白膜仍相对较厚或部分脱落,平均脱落时间为(10.2±1.8)d(P<0.05)。术后1d和3d,观察组VAS评分均低于对照组(P<0.05);术后7d,两组间VAS评分比较(观察组:0.23±0.4;对照组:0.43±0.6),差异无统计学意义(P>0.05)。80例患者中,术后第3天观察组(17.5%)仍吞咽不适概率低于对照组(42.5%)(P<0.05)。术后3d,观察组黏膜肿胀消退率(82.5%)优于对照组(62.5%)(P<0.05)。术后出血概率观察组(7.5%)与对照组(15.0%)比较,差异无统计学意义(P>0.05)。观察组无一例出现术后呼吸困难,对照组有1例出现术后呼吸困难。术后3个月,两组中无一例患者出现复发。结论显微支撑喉镜下CO_(2)激光显微手术治疗会厌囊肿视野清晰、创伤小、出血量少、恢复快,但与等离子射频消融会厌囊肿比较手术时间稍有延长。Objective To investigate the clinical fficacy of CO_(2),laser and plasma radiofrequency ablation in removing epiglottic cysts under selfretaininglaryngoscope.Methods A retrospective analysis on 80 patients diagnosed with epiglottis cysts during the period from 2019-01 to 2020-05 was performed.The patients were divided into an observation group and a control group by surgical methods,40 patients in each.The patients in the observation group were treated with 4-6 W CO_(2),laser under self-retaining laryngoscope with continuous output.Those in the control group were given plasma radiofrequency ablation under self-retaining laryngoscope.The operation time and intraoperative bleeding of the two groups were recorded.For both groups,visual analogue scale(VAS)was used to record pain levels 1,3 and 7 days after the operation respectively.Moreover,the time of postoperative albuginea shedding,recurrence rate,adverse reactions and complication rates of the two groups were observed and compared 3 months after the operation.Results The operation time(9.35±2.0)min in the observation group was slightly longer than that(6.50±4.4)min in the control group(P<0.05),and the intraoperative bleeding volume(1.63±0.9)ml in the former was less than that(3.20±1.2)ml in the later(P<0.05).One week after the operation,the albuginea in the observation group basically fell off mean shedding time(7.20±1.2)d,and the rosy mucosa could be seen.On the other hand,the albuginea in the control group was still relatively thick or partially shed mean shedding time(10.2±1.8)d,and the difference was significant(P<0.05).On the lst and 3rd day after the operation,the VAS score of the observation group was lower than of the control group(P<0.05).On the 7th day after the operation,the VAS score of the observation group and control group was 0.23+0.4,and 0.43±0.6 respectively,and the difference between them was not statistically significant(P>0.05).As to the 80 patients,the probability(17.5%us.42.5%)of painful swallowing on the 3rd day after surgery was l

关 键 词：激光 会厌囊肿 低温等离子体消融术 

分 类 号：R616.4[医药卫生—外科学] R767.5[医药卫生—临床医学]