等离子射频联合喉模置入治疗病变广泛的复发性喉气管乳头状瘤的疗效分析

Coblation and silicon stent implantation for recurrent laryngeal papilloma with extensive lesions

目的:探讨等离子射频和喉腔支撑材料置入术治疗病变广泛的复发性喉气管乳头状瘤的可行性和远期疗效。方法:回顾性分析2009-03-2016-04期间收治的13例(男8例、女5例)复发性喉乳头状瘤成年患者,年龄28~67岁。本次就诊前均在外院接受过1~5次不同方式的外科处理,末次至本次手术间隔时间2~6个月。所有患者术前、术后均接受电子或频闪喉镜检查以及嗓音质量评估。全身麻醉支撑喉镜下行喉气管乳头状瘤等离子射频消融和喉腔支撑材料(硅胶片7例、硅胶管4例、T管2例)置入术。术后随访时间为12~76个月。结果:喉镜发现病变分别位于声带、前连合、室带、后连合、杓会厌皱襞、会厌等部位,部分累及声门下区和气管,均存在不同程度的前连合或(和)后连合等部位粘连,2例存在轻度气管狭窄。所有患者在术后2~6周拔除喉腔支撑材料,除2例2个月后再次发生前连合粘连,余均未发生明显的声带粘连或喉气管狭窄。术后的嗓音障碍指数和总嘶哑度均较术前明显改善。术后1年内复发3例,术后2年内复发4例,病变均位于室带、声门下区和气管内,随访期间未复发者6例。复发者再次接受射频消融术,随访期间内未再出现复发。该组病例未发生严重并发症。结论:等离子射频可满意切除病变广泛的复发性喉气管乳头状瘤,同时采用不同的支撑材料保护手术创面能有效地预防创面粘连和喉气管狭窄的发生,提高嗓音质量。

Objective：To evaluate the feasibility and long-term outcome of radiofrequency coblation combined with silicon stent implantation in the treatment of recurrent laryngeal papilloma with extensive lesions.Method：From March 2009 to April 2016,a total of 13 patients（8 males,5 females;aged 28-67 years）who suffered recurrent laryngeal papilloma were enrolled in this retrospective study.All the cases had undergone at least one operation at other hospitals before this hospitalization.The recurrence interval（RI）of these cases ranged from 2 to6 months.Video-laryngoscopy or stroboscopy were preformed preoperatively and postoperatively,as well as vocal function assessment.These cases underwent radiofrequency coblationin combination of different stent implantation（member,7 cases;tube,4 cases;T-shaped tube,2 cases）under general anesthesia.The follow-up was 12 to 76 months.Result：Laryngoscopy revealed that the lesions mainly located in the vocal folds,anterior commissure,ventricular band,posterior commissure,epiglottis and even in subglottic area.Varying extent of mucosal adhesion of anterior or/and posterior commissure were observed in all cases,and two cases suffered mild subglottic tracheal stenosis.Two to six weeks after surgery,the silicon stent were removed and no mucosal adhesion were found except for 2 cases who suffered mucosal adhesion of anterior commissure again.Compared to preoperative scores,VHI-10 and G scores showed the significant improvement of voice quality postoperatively in all cases.The recurrence of papilloma was observed in 3 cases during 1-year follow-up,and 4 cases during 2-year follow-up,no recurrence in 6 cases.These recurrence lesions mainly located in ventricular band,subglottic area and trachea.However,no recurrence occurred in these cases who received ablation again.No serious complications were observed in these cases.Conclusion：Radiofrequency ablation may be an effective approach in the treatment of recurrent laryngeal papilloma with extensive lesions.One-stage application of suitable silicon stents can effectively prevent the adhesion of the wound and the onset oflaryngo-tracheal stenosis,and improve the quality of voice.