Chen D H, Zheng H L, Zhang C Y, Li M, Liu F, Zhu M H, Chen S C
Department of Otorhinolaryngology Head and Neck Surgery, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2017 Nov 20;31(22):1711-1715. doi: 10.13201/j.issn.1001-1781.2017.22.003.
To evaluate the feasibility and long-term outcome of radiofrequency coblation combined with silicon stent implantation in the treatment of recurrent laryngeal papilloma with extensive lesions. From March 2009 to April 2016, a total of 13 patients (8 males, 5 females; aged 28-67 years) who suffered recurrent laryngeal papilloma were enrolled in this retrospective study. All the cases had undergone at least one operation at other hospitals before this hospitalization. The recurrence interval (RI) of these cases ranged from 2 to 6 months. Video-laryngoscopy or stroboscopy were preformed preoperatively and postoperatively, as well as vocal function assessment. These cases underwent radiofrequency coblationin combination of different stent implantation (member, 7 cases; tube, 4 cases; T-shaped tube, 2 cases) under general anesthesia. The follow-up was 12 to 76 months. Laryngoscopy revealed that the lesions mainly located in the vocal folds, anterior commissure, ventricular band, posterior commissure, epiglottis and even in subglottic area. Varying extent of mucosal adhesion of anterior or/and posterior commissure were observed in all cases, and two cases suffered mild subglottic tracheal stenosis. Two to six weeks after surgery, the silicon stent were removed and no mucosal adhesion were found except for 2 cases who suffered mucosal adhesion of anterior commissure again. Compared to preoperative scores, VHI-10 and G scores showed the significant improvement of voice quality postoperatively in all cases. The recurrence of papilloma was observed in 3 cases during 1-year follow-up, and 4 cases during 2-year follow-up, no recurrence in 6 cases. These recurrence lesions mainly located in ventricular band, subglottic area and trachea. However, no recurrence occurred in these cases who received ablation again. No serious complications were observed in these cases. Radiofrequency ablation may be an effective approach in the treatment of recurrent laryngeal papilloma with extensive lesions. One-stage application of suitable silicon stents can effectively prevent the adhesion of the wound and the onset oflaryngo-tracheal stenosis, and improve the quality of voice.
评估射频消融联合硅支架植入治疗广泛病变的复发性喉乳头状瘤的可行性及长期疗效。2009年3月至2016年4月，本回顾性研究纳入了13例复发性喉乳头状瘤患者（男8例，女5例；年龄28 - 67岁）。所有病例在本次住院前均在其他医院至少接受过一次手术。这些病例的复发间隔时间为2至6个月。术前及术后均进行了电子喉镜或频闪喉镜检查以及嗓音功能评估。这些病例在全身麻醉下接受了射频消融联合不同支架植入（喉膜，7例；喉管，4例；T形管，2例）。随访时间为12至76个月。喉镜检查显示病变主要位于声带、前联合、室带、后联合、会厌，甚至声门下区。所有病例均观察到不同程度的前联合或/和后联合黏膜粘连，2例出现轻度声门下气管狭窄。术后2至6周取出硅支架，除2例再次出现前联合黏膜粘连外，未发现黏膜粘连。与术前评分相比，所有病例术后VHI - 10和G评分显示嗓音质量有显著改善。1年随访期间3例出现乳头状瘤复发，2年随访期间4例复发，6例未复发。这些复发病变主要位于室带、声门下区及气管。然而，再次接受消融的病例未再复发。这些病例未观察到严重并发症。射频消融可能是治疗广泛病变的复发性喉乳头状瘤的有效方法。一期应用合适的硅支架可有效防止创面粘连及喉气管狭窄的发生，并改善嗓音质量。
