Havel Miriam, Sroka Ronald, Englert Elsa, Stelter Klaus, Leunig Andreas, Betz Christian S
Department of Otorhinolaryngology, Head and Neck Surgery, University of Munich, Marchioninistr. 15, 81377 Munich, Germany.
Lasers Surg Med. 2012 Sep;44(7):558-63. doi: 10.1002/lsm.22053. Epub 2012 Jul 26.
The need for reduction of post-tonsillectomy hemorrhage has led to promotion of tonsillotomy techniques for tonsil tissue reduction in obstructive tonsillar hypertrophy. This trial compares ablative tissue effects using 1,470 nm diode laser and carbon dioxide laser for tonsillotomy in an intraindividual design.
21 children aged 3-13 years (mean age 6.3 years) underwent laser tonsillotomy for obstructive tonsillar hypertrophy in this double blind, prospective, randomized, clinical feasibility trial. In each of the blinded patients, tonsillotomy was performed using fiber guided 1,470 nm diode laser (contact mode, 15 W power) on the one side and carbon dioxide laser (12 W power) on the other side. An independent, blinded physician documented clinical presentation and patients' symptoms preoperatively and on Days 1, 3, 7, 14, and 21 post-operatively using standardized questionnaire including VAS for each side separately.
The mean duration of operative treatment was 2.7 min using 1,470 nm laser and 4.9 min using carbon dioxide laser respectively. Intraoperative bleeding and the frequency of bipolar forceps use for intraoperative bleeding control was significantly less using 1,470 nm diode laser system. There was no difference in post-operative pain scores between the carbon dioxide laser treated and the 1,470 nm fiber guided diode laser treated side. No infections, hemorrhages or other complications occurred in the course of the 3 weeks post-operative period.
A fiber-guided 1,470 nm diode laser system offers an efficient and safe method for tonsillotomy as treatment of obstructive tonsillar hypertrophy. Compared to our standard practice (carbon dioxide laser), 1,470 nm laser application provides comparable tissue ablation effects with less intraoperative bleeding and shorter operation time.
减少扁桃体切除术后出血的需求促使人们推广扁桃体切除术技术，用于治疗阻塞性扁桃体肥大时减少扁桃体组织。本试验采用个体内设计，比较1470纳米二极管激光和二氧化碳激光在扁桃体切除术中的消融组织效果。
在这项双盲、前瞻性、随机、临床可行性试验中，21名3至13岁（平均年龄6.3岁）的儿童因阻塞性扁桃体肥大接受了激光扁桃体切除术。在每例盲法患者中，一侧使用光纤引导的1470纳米二极管激光（接触模式，功率15瓦）进行扁桃体切除术，另一侧使用二氧化碳激光（功率12瓦）。一名独立的盲法医生术前以及术后第1、3、7、14和21天使用标准化问卷分别记录每侧的临床表现和患者症状，包括视觉模拟评分法。
使用1470纳米激光的平均手术治疗时间为2.7分钟，使用二氧化碳激光的平均手术治疗时间为4.9分钟。使用1470纳米二极管激光系统时，术中出血以及用于控制术中出血的双极镊子使用频率显著更低。二氧化碳激光治疗侧和1470纳米光纤引导二极管激光治疗侧的术后疼痛评分没有差异。术后3周内未发生感染、出血或其他并发症。
光纤引导的1470纳米二极管激光系统为治疗阻塞性扁桃体肥大的扁桃体切除术提供了一种高效且安全的方法。与我们的标准做法（二氧化碳激光）相比，应用1470纳米激光可提供相当的组织消融效果，术中出血更少且手术时间更短。
