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分次二氧化碳激光扁桃体切除术:治疗慢性扁桃体炎的新技术。

Tonsillotomy by a Fractional Carbon Dioxide Laser: A New Technique in the Treatment of Chronic Tonsillitis.

作者信息

Costa Heloisa Juliana Zabeu Rossi, Di Francesco Renata Cantisani, Giancoli Suzana Maria, de Miranda Fernando Mathias Pereira, Bento Ricardo Ferreira

机构信息

Department of Otorhinolaryngology, University of Sao Paulo Medical School, Sao Paulo, Brazil.

出版信息

J Lasers Med Sci. 2022 Nov 25;13:e51. doi: 10.34172/jlms.2022.51. eCollection 2022.

Abstract

Chronic tonsillitis has a global prevalence, ranging from 5% to 12%. Its clinical manifestations, like recurrent acute tonsillitis, tonsils hypertrophy, caseum and halitosis, can lead adult patients to be submitted to palatine tonsillectomy, surgery that has morbidity and the potential risk of complications, including severe bleeding. This article proposes a new therapy for chronic tonsillitis in adult patients using a fractional carbon dioxide (CO2) laser, which is a fast, minimally invasive procedure capable of removing the need for the traditional tonsillectomy in many patients. The present research aimed to verify the efficacy of tonsillotomy by fractional ablation using the CO2 laser by comparing the number of bacterial infections, tonsils hypertrophy, halitosis and caseum; it is also aimed at analyzing the benefits, risks and complications of the technique. In this clinical prospective study, 20 patients were subjected to one session of tonsillotomy by fractional ablation and were followed up for a year. The control group was formed by the same patients in the pre-procedure period (one year) without treatment. Statistical analysis: The Wilcoxon paired test, Friedman tests, and multiple non-parametric comparisons were utilized to analyze the data (significance level of 5%). No complications occurred, and the procedure was fast (30 seconds), safe and tolerated well without general anesthesia. After 1 year, there was a total remission of recurrent acute tonsillitis in 95% of the patients, and after 6 months there was a statistically significant improvement in halitosis and caseum, and tonsils size reduction (<0.05). The level of satisfaction average was 10 after 3 months and 8 after one year. tonsillotomy by fractional ablation using the CO2 laser is a safe, efficient procedure for chronic tonsillitis in adults, and it can be incorporated into daily clinical practice.

摘要

慢性扁桃体炎在全球范围内普遍存在,患病率为5%至12%。其临床表现,如复发性急性扁桃体炎、扁桃体肥大、扁桃体隐窝脓栓和口臭,可导致成年患者接受腭扁桃体切除术,该手术存在发病率和并发症的潜在风险,包括严重出血。本文提出了一种使用分数二氧化碳(CO2)激光治疗成年慢性扁桃体炎的新疗法,这是一种快速、微创的手术,能够使许多患者无需进行传统的扁桃体切除术。本研究旨在通过比较细菌感染、扁桃体肥大、口臭和扁桃体隐窝脓栓的数量,验证使用CO2激光进行分数消融扁桃体切开术的疗效;还旨在分析该技术的益处、风险和并发症。在这项临床前瞻性研究中,20名患者接受了一次分数消融扁桃体切开术,并进行了一年的随访。对照组由术前(一年)未接受治疗的同一批患者组成。统计分析:采用Wilcoxon配对检验、Friedman检验和多个非参数比较来分析数据(显著性水平为5%)。未发生并发症,手术快速(30秒)、安全且无需全身麻醉,耐受性良好。1年后,95%的患者复发性急性扁桃体炎完全缓解,6个月后,口臭和扁桃体隐窝脓栓有统计学意义的改善,扁桃体大小缩小(<0.05)。3个月后的平均满意度为10分,1年后为8分。使用CO2激光进行分数消融扁桃体切开术是一种治疗成人慢性扁桃体炎的安全、有效方法,可纳入日常临床实践。

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本文引用的文献

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Tonsillectomy in adults: Analysis of indications and complications.成人扁桃体切除术:适应证与并发症分析
Auris Nasus Larynx. 2018 Jun;45(3):517-521. doi: 10.1016/j.anl.2017.08.012. Epub 2017 Sep 18.

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