Ilgner J, Emmerling O, Biesterfeld S, Westhofen M
Klinik für Hals-Nasen-Ohrenheilkunde und Plastische Kopf- und Halschirurgie des Universitätsklinikums Aachen, Germany.
Laryngorhinootologie. 2002 May;81(5):346-50. doi: 10.1055/s-2002-28345.
While laser surgical methods in Otorhinolaryngology have become widely established, their use in revision surgery for chronic-polypous sinusitis has been regarded as hazardous due to the vicinity of the anterior skull base and the orbit. However, new experience with laser-tissue interaction in contact irradiation together with effective power feedback control mechanisms require a re-evaluation of laser revision surgery in this field.
After 742 primary, endonasal-microscopic sinus surgery procedures, 86 patients had 128 Nd:YAG-laser sessions performed within an interval of 1 - 24 months after primary surgery for recurrent polyposis, which had been irresponsive to medication. The maximum power delivered was 10 to 20 W.
Recurrent polyposis appeared mostly in the maxillo-ethmoid angle, followed by the maxillary sinus roof and the maxillary sinus bottom. In 63 of 86 patients, no further polyposis was seen after laser surgery. If more than one laser session had to be performed, recurrent polyposis appeared in a different region in most cases. Those areas lasered first showed a reduced tendency to recurrence. There was moderate bleeding during laser surgery in 6 cases with reduced visibility, but no other serious complications were recorded.
Laser surgery for chronic-polypous sinusitis is an alternative to conventional revision surgery, if medical treatment fails and recurrent polyposis is confined to certain regions. Feedback-controlled contact laser power delivery adds further therapeutic safety when applied next to the anterior skull base and the orbit.
虽然激光手术方法在耳鼻咽喉科已广泛应用，但由于其靠近前颅底和眼眶，在慢性息肉性鼻窦炎的翻修手术中使用一直被认为具有危险性。然而，激光与组织相互作用在接触式照射方面的新经验以及有效的功率反馈控制机制，需要对该领域的激光翻修手术进行重新评估。
在742例初次鼻内镜下鼻窦手术之后，86例患者因复发性息肉病对药物治疗无效，在初次手术后1至24个月内接受了128次Nd:YAG激光治疗。最大输出功率为10至20瓦。
复发性息肉病大多出现在上颌筛窦角，其次是上颌窦顶和上颌窦底。86例患者中有63例在激光手术后未见进一步息肉复发。如果必须进行不止一次激光治疗，复发性息肉病大多出现在不同区域。首次接受激光治疗的部位复发倾向降低。6例患者在激光手术期间有中度出血，视野受限，但未记录到其他严重并发症。
如果药物治疗失败且复发性息肉病局限于特定区域，激光手术可作为慢性息肉性鼻窦炎传统翻修手术的替代方法。在靠近前颅底和眼眶处应用时，反馈控制的接触式激光能量输送可进一步提高治疗安全性。
