Department of Otolaryngology-Head and Neck Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Otolaryngology-Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan.
JAMA Otolaryngol Head Neck Surg. 2018 Mar 1;144(3):222-230. doi: 10.1001/jamaoto.2017.2899.
In-office angiolytic laser procedures have been used successfully as an alternative treatment for vocal fold polyps; little is known in detail about the treatment outcomes and adverse events.
To examine the outcomes and incidence rates of adverse events associated with in-office angiolytic laser procedures with or without concurrent polypectomy as an alternative treatment for vocal fold polyps.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study at a tertiary medical center. We identified 114 consecutive patients with vocal polyps who underwent in-office angiolytic laser treatments between January 1, 2014, and August 31, 2016. After the exclusion of 17 with missing or incomplete data, 97 were enrolled.
In-office 532-nm laser procedures with or without concurrent polypectomy.
Between 1 and 2 months after the surgical procedures, we collected the following outcome data: videolaryngostroboscopy, perceptual rating of voice quality, acoustic analysis, maximal phonation time, and subjective rating of voice quality using a visual analogue scale and 10-item voice handicap index.
This study enrolled 97 patients (mean [SD] age, 45.6 [11.3] years; 48 [49%] male). The mean duration of symptoms was 10.1 months (range, 1-60 months). Twenty-nine patients (30%) had angiolytic laser procedures only, while 68 (70%) received laser with concurrent polypectomy. Both treatment modalities offered significant improvements. Only 1 patient (1%) receiving angiolytic laser with concurrent polypectomy underwent another treatment session, so this group had significantly less need for multiple treatments than those receiving laser treatment alone (6 [21%]; effect size, -1.57; 95% CI, -2.77 to -0.36). We identified 8 adverse events (8% of the cases): vocal fold edema (n = 5), vocal hematoma (n = 2), and vocal ulceration (n = 1). Patients treated with laser plus concurrent polypectomy had significantly fewer adverse events than those treated with angiolytic laser alone (2 [3%] vs 6 [21%]; effect size, 1.20; 95% CI, 0.26 to 2.13).
In-office angiolytic laser procedures can be an effective alternative treatment for vocal polyps, although with possible need for multiple treatment sessions and occasional occurrence of minor postoperative adverse events. Concurrent polypectomy following laser coagulation allows less laser energy delivery and reduces the risk of postoperative adverse events and the need for additional treatment sessions.
在诊室内进行血管溶解激光治疗已成功用作治疗声带息肉的替代方法；但对于治疗结果和不良事件的详细信息知之甚少。
检查与单独使用血管溶解激光治疗或联合息肉切除术作为声带息肉替代治疗相关的治疗结果和不良事件的发生率。
设计、地点和参与者：在一家三级医疗中心进行的回顾性队列研究。我们确定了 114 例连续的声带息肉患者，他们在 2014 年 1 月 1 日至 2016 年 8 月 31 日期间接受了在诊室内进行的血管溶解激光治疗。排除 17 例数据缺失或不完整的患者后，共纳入 97 例。
在诊室内使用 532nm 激光治疗，联合或不联合息肉切除术。
在手术治疗后 1 至 2 个月，我们收集了以下结局数据：视频喉镜检查、语音质量感知评分、声学分析、最大发音时间和使用视觉模拟量表和 10 项嗓音障碍指数对嗓音质量的主观评分。
本研究纳入了 97 例患者（平均[标准差]年龄，45.6[11.3]岁；48[49%]为男性）。平均症状持续时间为 10.1 个月（范围为 1-60 个月）。29 例（30%）仅接受了血管溶解激光治疗，而 68 例（70%）接受了激光联合息肉切除术。两种治疗方法均有显著改善。仅 1 例（1%）接受联合息肉切除术的患者需要再次治疗，因此该组比仅接受激光治疗的患者需要多次治疗的情况明显减少（6[21%]；效应量，-1.57；95%置信区间，-2.77 至-0.36）。我们共发现了 8 例不良事件（占病例的 8%）：声带水肿（n=5）、声带血肿（n=2）和声带溃疡（n=1）。接受激光联合息肉切除术治疗的患者与仅接受血管溶解激光治疗的患者相比，不良事件明显更少（2[3%]比 6[21%]；效应量，1.20；95%置信区间，0.26 至 2.13）。
在诊室内进行血管溶解激光治疗可作为声带息肉的有效替代治疗方法，但可能需要多次治疗，并且偶尔会出现轻微的术后不良事件。在激光凝固后进行息肉切除术可以减少激光能量的输送，降低术后不良事件的风险和额外治疗的需要。
