纤维喉镜下激光治疗喉部良性疾患21例体会

TREATMENT OF BENIGN LARYNGEAL CHANGES BY LASER UNDER FIBROTIC LARYNGOSCOPE

目的：总结纤维喉镜下激光治疗喉部良性疾患的方法与疗效。方法：回顾性分析２１例患者的治疗方法及疗效。结果：声带息肉、声带小结及喉囊肿均一次治愈；喉乳头状瘤一次治愈１例，２次２例，１例经４次手术方切净后又复发。术后发音均明显改善。结论：纤维喉镜下激光治疗喉良性疾患效果满意，优于间接喉镜、直达喉镜及喉裂开切除术，特别适用于间接喉镜下喉部手术困难者。术中应注意：①对广泛的病变如喉乳头状瘤，一次治疗范围不可过大。②两次手术的间隔时间以一月为宜。③对较大的息肉，宜先小功率散焦间歇照射，然后加大功率聚焦汽化切割；对带蒂的较大息肉，不宜先照射蒂部，以免发生意外。

OBJECTIVE: To study treatment of benign laryngeal changes by laser under fibrotic laryngoscope. METHOD: Data of 21 patients with benign laryngeal changes has been retrospectively studied. RESULTS: All patients with vocal nodules, vocal cord polyp and laryngocele have recovered by single therapy. One patient with papilomatosis of larynx has recovered by single therapy and two needed two therapies, and another one needed four time operations. All patients got recovered in phonation. CONCLUSION: Satisfied results have been received for treatment of benign laryngeal changes by laser under fibrotic laryngoscope and it was better than median laryngotomy and excision under direct and indirect laryngoscope. For those who are difficult under indirect laryngoscope, fibrotic laryngoscope is especially useful. Important notes: (1) For extensive changes such as papilomatosis, operation field should not be large in a single therapy; (2) One month interval is necessary between two operations; (3) For large polyp, take defocussing irradiation with low power followed by focussing cut with higher power. For large polyp with peduncle, it is proper to irradiate the peduncle to avoid accident.