Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston.
Engineering Physics Department, Polytechnique Montreal, Montreal, Quebec, Canada.
JAMA Otolaryngol Head Neck Surg. 2018 Sep 1;144(9):831-837. doi: 10.1001/jamaoto.2018.1375.
Recurrent respiratory papillomatosis (RRP) is a viral-induced disease caused by human papillomavirus and the second leading cause of dysphonia in children; however, neither a cure nor a definitive surgical treatment is currently available for RRP. Although laser therapy is often used in the treatment of RRP, the lack of real-time laser-tissue interaction feedback undermines the ability of physicians to provide treatments with low morbidity. Therefore, an intraoperative tool to monitor and control laser treatment depth is needed.
To investigate the potential of combining optical coherence tomography (OCT) with laser therapy for patient-tailored laryngeal RRP treatments.
DESIGN, SETTING, AND PARTICIPANTS: This in vivo study was performed at the Massachusetts Eye and Ear Infirmary from February 1, 2017, to September 1, 2017. Three-dimensional OCT images were acquired before, during, and after photoangiolytic laser therapy in 10 pediatric patients with a history of papilloma growth who presented with lesions and hoarseness.
Whether intraoperative OCT monitoring of changes in optical scattering and absorption provides quantitative information to control thermal damage in tissue.
Among the 10 pediatric patients (age range, 4-11 years; 6 male) included in the study, high-resolution OCT images revealed epithelial hyperplasia with clear RRP lesion margins. Images acquired during therapy indicated coagulation deep in tissue, and posttherapy images showed the ability to quantify the amount of tissue ablated by the photoangiolytic laser.
Concurrent use of OCT imaging and laser therapy may improve postoperative outcomes for patients with RRP by delivering an optimal, patient-tailored treatment. Additional studies investigating the correlation between optical properties with vocal outcomes are required.
复发性呼吸道乳头瘤病（RRP）是由人乳头瘤病毒引起的病毒性疾病，是儿童第二大发音障碍原因；然而，目前既没有针对 RRP 的治愈方法，也没有明确的手术治疗方法。尽管激光疗法常用于 RRP 的治疗，但缺乏实时的激光组织相互作用反馈，这削弱了医生提供低发病率治疗的能力。因此，需要一种用于监测和控制激光治疗深度的术中工具。
研究将光学相干断层扫描（OCT）与激光疗法相结合用于针对患者的喉部 RRP 治疗的潜力。
设计、设置和参与者：这项体内研究于 2017 年 2 月 1 日至 9 月 1 日在马萨诸塞州眼耳医院进行。对 10 名有乳头状瘤生长史、出现病变和声音嘶哑的儿科患者，在进行光消融激光治疗之前、期间和之后采集三维 OCT 图像。
术中 OCT 监测光散射和吸收变化是否提供定量信息来控制组织中的热损伤。
在纳入的 10 名儿科患者（年龄 4-11 岁；6 名男性）中，高分辨率 OCT 图像显示上皮增生，RRP 病变边界清晰。治疗期间采集的图像显示组织深处的凝固，治疗后的图像显示出量化光消融激光所消融的组织量的能力。
OCT 成像与激光疗法的同时使用可能通过提供最佳的、针对患者的治疗来改善 RRP 患者的术后结果。需要进行更多研究来调查光学特性与声音结果之间的相关性。
