Janda P, Sroka R, Betz C S, Grevers G, Leunig A
Klinik und Poliklinik für Hals-, Nasen- und Ohrenkranke der Ludwig-Maximilians-Universität München, Klinikum Grosshadern.
Laryngorhinootologie. 2002 Jul;81(7):484-90. doi: 10.1055/s-2002-33288.
Since the early 80's, chronic nasal obstruction due to hyperplastic turbinates is treated by laser light. Comparative clinical studies were performed to assess the clinical outcome of laser assisted endonasal turbinate surgery in longterm.
By means of a pulsed Ho:YAG laser emitting light at lambda = 2100 nm (0.8 - 1.2 J/pulse, 4 - 8 Hz), 69 patients suffering from nasal obstruction due to allergic rhinitis (46 %) and vasomotor rhinitis (54 %) were treated under local anesthesia. Furthermore, 50 patients (52 % with allergic rhinitis and 48 % with vasomotor rhinitis) were treated by means of a GaAlAs-diode laser (c. w., lambda = 940 nm, 8 - 10 W). The treatment time took 3 - 10 min/turbinate and nasal packing was not necessary after the laser procedure. The study was conducted by a standardized questionnaire, photo documentation, allergy test, mucociliar function test, rhinomanometry, and acoustic rhinometry.
Within 4 weeks after laser treatment, an improvement of nasal airflow correlating to the extent of the ablated turbinate tissue could be determined in more than 80 % of the patients. Rhinomanometry revealed a significant improvement of the nasal airflow 6 months and 1 year after the laser treatment compared to the preoperative data. Side effects like nasal dryness and pain were rare (< 5 %). Diode laser treatment revealed more effective results than Ho:YAG laser treatment, however there was no significant difference between the two investigated groups. Patients suffering from vasomotor rhinitis showed far better results in long term in comparison to allergic rhinitis patients.
Ho:YAG and diode laser treatment can be performed as an outpatient procedure under local anesthesia in a short treatment time with promising results. It could become a time and cost effective treatment modality in endonasal laser surgery.
自80年代初以来,增生性鼻甲引起的慢性鼻阻塞一直通过激光治疗。进行了比较临床研究以长期评估激光辅助鼻内鼻甲手术的临床结果。
使用波长为λ = 2100 nm(0.8 - 1.2 J/脉冲,4 - 8 Hz)的脉冲Ho:YAG激光,在局部麻醉下治疗69例因过敏性鼻炎(46%)和血管运动性鼻炎(54%)导致鼻阻塞的患者。此外,50例患者(52%为过敏性鼻炎,48%为血管运动性鼻炎)接受了GaAlAs二极管激光(连续波,λ = 940 nm,8 - 10 W)治疗。每个鼻甲的治疗时间为3 - 10分钟,激光治疗后无需鼻腔填塞。该研究通过标准化问卷、照片记录、过敏测试、黏液纤毛功能测试、鼻阻力测量和鼻声反射测量进行。
激光治疗后4周内,超过80%的患者鼻气流改善与切除的鼻甲组织范围相关。鼻阻力测量显示,与术前数据相比,激光治疗后6个月和1年鼻气流有显著改善。鼻干和疼痛等副作用很少见(<5%)。二极管激光治疗显示出比Ho:YAG激光治疗更有效的结果,但两个研究组之间没有显著差异。与过敏性鼻炎患者相比,血管运动性鼻炎患者长期效果要好得多。
Ho:YAG和二极管激光治疗可在局部麻醉下作为门诊手术进行,治疗时间短,效果良好。它可能成为鼻内激光手术中一种节省时间和成本的治疗方式。