Hirano Shigeru, Yamashita Masaru, Kitamura Morimasa, Takagita Shin-ichi
Dept of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto 606-8507, Japan.
Ann Otol Rhinol Laryngol. 2006 Apr;115(4):253-9. doi: 10.1177/000348940611500402.
Ectasias and varices of the vocal fold are microvascular lesions that are often due to chronic abuse of the voice, and are occasionally encountered in association with other disorders such as polyps, Reinke's edema, and hematoma. The KTP laser can be used for photocoagulation of small vascular lesions, because the laser beam is well absorbed by hemoglobin, and damage to the epithelium is minimal. The present pilot study examined how the KTP laser could be used for microvascular lesions and their associated lesions.
Twelve patients who had undergone phonomicrosurgery were enrolled in the present study. The microvascular lesions were treated by photocoagulation with the laser set at a low power of 1.5 W in the continuous mode, while preserving the epithelium, and associated lesions were then treated by microdissection with cold instruments. The postoperative phonatory function was assessed by maximum phonation time, a perceptual test rating (GRBAS scale), and stroboscopy.
The procedures were completed successfully in all cases. An exceptional case of a small hemorrhagic polyp allowed treatment with the laser only. The postoperative stroboscopic findings, maximum phonation time, and perceptual test rating all showed significant improvement compared with the preoperative state. No adverse effects, such as scarring or reduction of the mucosal wave, were observed in the current series.
KTP laser photocoagulation is a relatively simple and safe procedure for treating microvascular lesions of the vocal fold. It is not recommended for photocoagulation of hemorrhagic polyps or hematomas, because such lesions have little blood flow inside and thus photocoagulation is usually impossible or requires too much laser energy. However, photocoagulation of perimeter or feeding vessels of such disorders may facilitate the following procedure by avoiding unnecessary bleeding, as well as preventing recurrence of hemorrhagic lesions.
声带扩张和静脉曲张是微血管病变，通常由长期滥用嗓音引起，偶尔也与其他疾病如息肉、任克氏水肿和血肿相关。KTP激光可用于小血管病变的光凝治疗，因为激光束能被血红蛋白很好地吸收，且对上皮的损伤最小。本初步研究探讨了KTP激光如何用于微血管病变及其相关病变。
12例接受过显微喉镜手术的患者纳入本研究。微血管病变采用连续模式下1.5W低功率激光进行光凝治疗，同时保留上皮，然后用冷器械进行显微解剖治疗相关病变。术后发声功能通过最大发声时间、感知测试评分（GRBAS量表）和频闪喉镜检查进行评估。
所有病例手术均成功完成。1例小出血性息肉的特殊病例仅用激光治疗。术后频闪喉镜检查结果、最大发声时间和感知测试评分均显示与术前状态相比有显著改善。本系列未观察到诸如瘢痕形成或黏膜波减弱等不良反应。
KTP激光光凝是治疗声带微血管病变相对简单且安全的方法。不建议用于出血性息肉或血肿的光凝治疗，因为此类病变内部血流很少，因此光凝通常无法进行或需要过多激光能量。然而，对此类疾病的周边或供血血管进行光凝可避免不必要的出血，同时防止出血性病变复发，从而便于后续手术。
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