- 期刊
以KTP雷射處理篩竇內復發之鼻息肉病變
Management of Recurrent Ethmoid Polyposis Using KTP Laser
摘要
背景：復發的慢性鼻竇炎合併廣泛性息肉增生是鼻竇手術中極具挑戰的課題，頑固的感染或再發性息肉被認為是鼻竇黏膜發生了不可逆的變化，清除此類的病變會因解剖構造的改變或是病人出血的傾向而使再手術變得困難。本研究提出以KTP雷射來協助清理篩竇復發性息肉增生的方法。 方法：本研究以回溯性的方式，收集11例復發性慢性鼻竇炎，皆為篩竇內部息肉復發病例，手術在鼻竇內視鏡協助下進行，以KTP/532 nm雷射來進行篩竇病灶的清理，病人的年紀由25歲到64歲，平均年齡為45.5±12.5歲，平均追蹤時間為26.9±9個月。 結果：病人術後恢復情形良好，無顯著後遺症，鼻竇空腔內瘢組織順利形成，上頜竇自然口及鼻額竇管維持暢通，病人鼻塞、鼻漏、頭痛的情形獲得顯著改善，只有兩側有局部復發的現象，必須在門診進行局部清理。 結論：KTP雷射可協助鼻竇內視鏡手術的進行，如果能選擇適當的病例，對於復發性鼻竇炎併息肉增生侷限於篩竇者是一項相當不錯的輔助治療工具。
並列摘要
BACKGROUND: Recurrent chronic sinusitis with diffuse polyposis is a challenging situation for sinus surgeons. Repeated recurrent infection in the polypoid sinonasal mucosa has traditionally being viewed as an irreversible pathological change, while eradication of diseased mucosa is often inevitable. Furthermore, tortured sinus anatomy, scar formation, and bleeding tendency have made the revision surgery very risky. The main purpose of this study was to investigate the feasibility of using KTP Laser to manage the recurrent ethmoid polyposis. METHODS AND MATERIAL: Eleven patients (male: female 10:1, mean age 45.5 ± 12.5 years-old) with recurrent ethmoid polyposis underwent revision endoscopic sinus surgery with the assistance of KTP Laser. Patients were all evaluated with sinus CAT scan before operation. Surgical outcomes were retrospectively obtained from medical record and/or post-operative sinus CAT scan. The mean follow-up period was 26.9 ± 9 months. RESULTS: The nasal obstruction, purulent rhinorrhea, and headache symptoms significantly improved in all patients; natural opening and nasal-frontal duct remain patent; the ethmoid cavities were well covered with scarring membrane. Two cases had localized recurrent polyp that were removed easily during the routine follow up visit. CONCLUSION: With its excellent hemostasis capability, omni-directional maneuverability, and flexible operation modes, KTP Laser is an ideal tool to manage recurrent ethmoid polyposis for selected cases.