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首页> 外文期刊>JAMA otolaryngology-- head & neck surgery >Office-based potassium titanyl phosphate laser-assisted endoscopic vocal polypectomy
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Office-based potassium titanyl phosphate laser-assisted endoscopic vocal polypectomy

机译：基于办公室的钛氧钛磷酸钾激光辅助内窥镜声带息肉切除术

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摘要

Importance: Vocal polyps are common exophytic laryngeal lesions that usually necessitate microscopic laryngeal surgery under general anesthesia. Office-based indirect laryngoscopic procedures provide an alternative management option and can be performed comfortably under flexible endoscopic guidance. Combining angiolytic potassium titanyl phosphate (KTP) laser treatment and flexible endoscopic polypectomy should alleviate the risks of surgery under general anesthesia and expedite lesion regression. Objectives: To combine angiolytic KTP laser treatment and endoscopic polyp removal and to evaluate the clinical applicability, treatment outcomes, and adverse effects of office-based KTP laser-assisted vocal polypectomy. Design: Case series of KTP laser treatment (n=16) and KTP laser-assisted polypectomy (n=20). Patients underwent pretreatment and 2- and 6-week posttreatment evaluation with videolaryngostroboscopy (VLS), maximal phonation time, and a 10-item voice handicap index. Perceptual (GRB [grade, roughness, breathiness] scale) and acoustic analyses were performed before and 6 weeks after treatment. Setting: Tertiary teaching hospital. Participants: Thirty-six outpatients with unilateral hemorrhagic vocal polyps. Interventions: Under local anesthesia, the KTP laser fiber was passed through the working channel of the flexible laryngoscope to photocoagulate the microvasculature of the polyp in all patients. Removal of coagulated vocal polyp using a flexible, endoscopic, blunt-ended grasping forceps immediately after KTP laser application was performed in the polypectomy group. Main Outcomes and Measures: Results of VLS, maximal phonation time, 10-item voice handicap index, and perceptual and acoustic analyses. Results: Six weeks after KTP laser treatment with and without polypectomy, 19 and 12 patients, respectively, experienced complete recovery and much improvement of mucosal wave. Maximal phonation time and the voice handicap index improved significantly 2 weeks after KTP laser with polypectomy (P < .01), whereas significant improvements were noted 6 weeks postoperatively in both treatment groups (P < .05). Acoustic and perceptual analyses also revealed significant improvements in both study groups (P < .05). During followup, we did not notice significant adverse effects. Conclusions and Relevance: Potassium titanyl phosphate laser-assisted vocal polypectomy is a safe, practical, and effective alternative option to treat hemorrhagic vocal polyps in the outpatient department, offering comparable but earlier therapeutic effects than KTP laser alone.
机译：重要性：声息肉是常见的外生性喉部病变，通常需要在全身麻醉下进行显微喉镜手术。基于办公室的间接喉镜手术提供了另一种管理选择，并且可以在灵活的内窥镜引导下舒适地进行。溶栓性磷酸钛氧钾（KTP）激光治疗和柔性内镜下息肉切除术的结合应可减轻全身麻醉下的手术风险并加快病变消退。目的：将溶栓性KTP激光治疗与内镜下息肉切除术相结合，并评估基于办公室的KTP激光辅助声带息肉切除术的临床适用性，治疗效果和不良反应。设计：KTP激光治疗（n = 16）和KTP激光辅助息肉切除术（n = 20）的病例系列。患者接受了电视喉镜检查（VLS）的治疗前以及治疗后2周和6周的评估，最长的发声时间和10个项的残障指数。在治疗前和治疗后6周进行知觉（GRB [等级，粗糙度，呼吸性]量表）和声学分析。地点：第三级教学医院。参加者：36例单侧出血性声带息肉的门诊患者。干预措施：在局部麻醉下，将KTP激光光纤穿过柔性喉镜的工作通道，以使所有患者的息肉微血管光凝。在息肉切除术组中，在应用KTP激光后立即使用柔性的，内窥镜的，末端为钝头的抓钳切除凝固的声带息肉。主要结果和措施：VLS结果，最大发声时间，10项语音障碍指数以及知觉和听觉分析。结果：在有或没有息肉切除术的情况下，KTP激光治疗六周后，分别有19例和12例患者完全恢复，粘膜波明显改善。 KTP激光息肉切除术后2周，最大发声时间和语音障碍指数显着改善（P <.01），而两个治疗组术后6周均注意到显着改善（P <.05）。声学和知觉分析也显示了两个研究组的显着改善（P <.05）。在随访期间，我们没有发现明显的不良反应。结论和相关性：磷酸钛氧钾激光辅助的声带息肉切除术是门诊治疗出血性声带息肉的安全，实用和有效的替代选择，与单独使用KTP激光相比，具有可比但更早的治疗效果。

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