Mayer T, Matlak M E, Dixon J, Johnson D G, McCloskey D
J Pediatr Surg. 1980 Dec;15(6):944-52. doi: 10.1016/s0022-3468(80)80308-3.
Controversy continues over the optimal method of resecting subglottic stenosis. Electrosurgery, cryosurgery and laser resection have all had some clinical success. We sought to compare these treatment methods in experimentally-created subglottic stenosis. Subglottic strictures were created transbronchoscopically in newborn lambs by electrocoagulating a rim of mucosa. Four weeks later, all had 20 to 90% occlusion documented bronchoscopically. Control animals were found to have dense submucosal fibrosis in the cricoid area. Remaining experimental animals were treated with: (1) electrosurgical resection; (2) cryosurgical treatment; (3) Neodymium-yag (Nd:Yag) laser at 20 watts; (4) Nd:Yag laser with 40 watts; or (5) carbon dioxide laser at 10 watts. Animals from each group were sacrificed at 5 and 30 days postresection and the tracheas were examined grossly and microscopically. Animals sacrificed at 30 days postresection were bronchoscoped at weekly intervals. Cryosurgical and electrosurgical resection resulted in 1-3 mm of thermal damage adjacent to the margin of resection at 5 days post-treatment. Mucosal ingrowth and healing were rapid and there was no development of stenosis or damage to underlying structures. Use of the Nd:Yag laser resulted in 10-20 mm of surrounding damage in animals sacrificed at 5 days. At 30 days posttreatment, there was mucosal healing but extreme underlying damage and redevelopment of stenosis at the level of treatment. The carbon dioxide laser-treated animals showed thermal damage present up to 2 mm in depth from resected areas at 5 days post-treatment. Mucosal regeneration proceeded rapidly. This study indicates that electrosurgical and cryosurgical resection for experimental subglottic stenosis create minimal thermal damage and are associated with comparably acceptable rates of mucosal ingrowth and healing. The carbon dioxide laser created comparable to slightly decreased thermal damage but suffers at present from lack of optimal visualization of the subglottic lesion.
关于声门下狭窄的最佳切除方法仍存在争议。电外科手术、冷冻手术和激光切除术都取得了一定的临床成功。我们试图在实验性创建的声门下狭窄中比较这些治疗方法。通过电凝黏膜边缘在新生羔羊中经支气管镜创建声门下狭窄。四周后，经支气管镜检查发现所有动物的狭窄程度为20%至90%。发现对照动物在环状软骨区域有致密的黏膜下纤维化。其余实验动物接受以下治疗：（1）电外科切除；（2）冷冻治疗；（3）20瓦钕钇铝石榴石（Nd:Yag）激光；（4）40瓦Nd:Yag激光；或（5）10瓦二氧化碳激光。每组动物在切除后5天和30天处死，对气管进行大体和显微镜检查。在切除后30天处死的动物每周进行一次支气管镜检查。冷冻手术和电外科切除在治疗后5天时，切除边缘相邻处有1 - 3毫米的热损伤。黏膜向内生长和愈合迅速，未出现狭窄或对深层结构的损伤。使用Nd:Yag激光在处死的5天龄动物中导致周围10 - 20毫米的损伤。在治疗后30天，有黏膜愈合，但在治疗水平处有严重的深层损伤和狭窄复发。二氧化碳激光治疗的动物在治疗后5天时，切除区域深度达2毫米处仍有热损伤。黏膜再生进展迅速。本研究表明，用于实验性声门下狭窄的电外科和冷冻手术切除造成的热损伤最小，且黏膜向内生长和愈合率相当可接受。二氧化碳激光造成的热损伤与之相当或略有降低，但目前存在声门下病变可视化不佳的问题。
