laser surgery

激光手术
  • 文章类型: Case Reports
    变形杆菌综合征是一种罕见的遗传疾病,其特征是身体各个部位的不对称生长,仅在单个病例中进行了描述。该患者表现为喉部和下咽部淋巴管瘤的复发表现,用激光手术治疗,全身治疗,和硬化疗法.报告的数据描述了耳鼻咽喉科的诊断和治疗,从2019年到2023年5月,海德堡大学医院的头颈部手术。使用柔性高清内窥镜和奥林巴斯的ViseraElite视频塔进行上气道的复发性内窥镜检查,汉堡。这位29岁的女性患者最初于2019年2月因左喉和下咽淋巴畸形而出现喘鸣和劳力性呼吸困难。2019年4月,Picibanil硬化疗法没有改善,因此,开始使用PIK3CA抑制剂alpelisib的全身治疗(2020年03月07日),并由于高副作用而停止治疗.在2021-2023年的过程中,由于波动的发现,进行了三次显微喉镜检查,激光手术切除和用Picibanil对淋巴管瘤进行了新的硬化治疗。在这些干预措施之后,可以在2023年5月之前建立稳定的疾病。激光手术疗法目前被描述为头颈部淋巴管瘤的首选疗法,并且在我们的患者中也显示出最高的疗效。特别是在气道阻塞的情况下,它可以迅速缓解症状。或者,手术风险较低,据报道,硬化疗法有局部改善,在本案中效果较差。罕见综合征需要多学科合作。在喉部淋巴管瘤病的病例中,除手术切除外,还应考虑其他治疗方案,尤其是在复发的情况下。
    Proteus syndrome is a rare genetic disease characterized by an asymmetrical growth of individual parts of the body and has only been described in single cases. This patient presented with recurrent manifestations of a laryngeal and hypopharyngeal lymphangioma, which were treated with laser surgery, systemic therapy, and sclerotherapy. The reported data depict the diagnosis and treatment in the department of otorhinolaryngology, head and neck surgery of the university hospital Heidelberg from 2019 until May 2023. The recurrent endoscopy of the upper airway was performed using a flexible HD-endoscope and the Visera Elite video tower from Olympus, Hamburg. The 29-year old female patient initially presented in February 2019 with stridor and exertional dyspnea due to a lymphatic malformation of the left larynx and hypopharynx. In April 2019 there was no improvement by sclerotherapy with Picibanil, so that systemic therapy with the PIK3CA inhibitor alpelisib was initiated (03-07/2020) and discontinued due to a high side effect profile. In the course of 2021-2023, three microlaryngoscopies with laser surgical resection and renewed sclerotherapy of the lymphangioma with Picibanil were carried out due to fluctuating findings. After these interventions a stable disease could be established until May 2023. Laser surgical therapy is currently described as the therapy of choice in lymphangiomas in the head and neck region and also showed the highest effectiveness in our patient. In case of airway obstruction in particular, it can bring rapid symptom relief. Alternatively, and with a lower surgical risk, local improvements have been reported by sclerotherapy, which was less effective in the presented case. Rare syndromic diseases require multidisciplinary collaboration. In the case of laryngeal lymphangiomatosis, other treatment options should be considered in addition to surgical excision, especially in the case of recurrence.
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  • 文章类型: English Abstract
    Lamellar keratoplasty is the most effective and safe method of surgical treatment of recurrent pterygium, providing restoration of the corneal frame and optical properties and a high anti-relapse effect due to the barrier properties of the lamellar graft. However, potential postoperative changes in the regularity of the anterior and posterior surfaces of the cornea (especially in case of advanced stage of fibrovascular tissue growth) do not always allow achieving high functional results of treatment. The article presents a clinical case that demonstrates the effectiveness and safety of excimer laser correction of refractive disorders after surgical treatment of pterygium.
    Послойная кератопластика является наиболее эффективным и безопасным методом хирургического лечения рецидивирующего птеригиума, обеспечивающим восстановление каркасных и оптических свойств роговицы, а также обусловливающим высокий противорецидивный эффект благодаря барьерным свойствам послойного трансплантата. Однако потенциальные послеоперационные изменения регулярности передней и задней поверхности роговицы (особенно в случае далекозашедшего роста фиброваскулярной ткани) не всегда позволяют достичь высоких функциональных результатов лечения. Представлено клиническое наблюдение, свидетельствующее об эффективности и безопасности выполнения эксимерлазерной коррекции рефракционных нарушений после хирургического лечения птеригиума.
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  • 文章类型: Case Reports
    未经证实:Cowden综合征是一种以多发性口腔错构瘤和内部恶性肿瘤风险增加为特征的遗传性疾病。这些粘膜皮肤病变可能会造成身体上的毁容和心理上的痛苦。因此,患者经常寻求治疗他们的破坏。由于其敏感的位置和高的复发风险,去除口腔错构瘤通常是一个挑战。
    未经批准:回顾临床应用,有效性,以及部分消融激光治疗Cowden综合征患者多发性口腔错构瘤的安全性。
    UNASSIGNED:关于口腔错构瘤治疗的全面文献综述,以及对一个说明性案例的讨论,该案例展示了33岁的患有Cowden综合征的男性患者使用部分消融二氧化碳(CO2)激光成功破坏病灶。
    UNASSIGNED:通过部分CO2激光汽化有效去除了多发性口腔错构瘤。没有感染,疤痕,皮炎,治疗后6个月未观察到病灶复发。
    UNASSIGNED:分数CO2激光汽化术可有效用于治疗与Cowden综合征相关的多发性口腔错构瘤。
    UNASSIGNED: Cowden\'s syndrome is a genetic disorder characterized by multiple oral hamartomas and an increased risk of internal malignancy. These mucocutaneous lesions can be physically disfiguring and psychologically distressing. As a result, patients frequently seek treatment for their destruction. Removal of oral hamartomas is often a challenge due to their sensitive location and high risk of recurrence.
    UNASSIGNED: To review the clinical use, effectiveness, and safety of a fractional ablative laser to treat multiple oral hamartomas in a patient with Cowden\'s syndrome.
    UNASSIGNED: A thorough literature review pertaining to treatment of oral hamartomas and a discussion of an illustrative case showcasing successful lesional destruction with a fractional ablative carbon dioxide (CO2) laser in a 33-year-old man with Cowden\'s syndrome.
    UNASSIGNED: Multiple oral hamartomas were effectively removed with fractional CO2 laser vaporization. No infection, scarring, dermatitis, nor lesional recurrence were observed 6 months post-treatment.
    UNASSIGNED: Fractional CO2 laser vaporization can be used effectively to treat multiple oral hamartomas associated with Cowden\'s syndrome.
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  • 文章类型: Review
    成人喉血管瘤罕见且不常见。孤立于声带游离边缘的血管瘤非常罕见。我们报告了2016年7月至2017年12月18个月期间在我们的语音诊所诊断的5例病例。所有五名患者均出现声音嘶哑,喉镜检查在声带边缘发现粉红色肿块,组织病理学提示血管瘤。采用喉二氧化碳(CO2)激光显微手术进行直接喉镜检查,无复发。我们建议显微激光喉镜(CO2)是声带血管瘤的治疗选择,术中无大出血。
    Adult laryngeal hemangiomas are rare and uncommon. Hemangioma isolated to the free-edge of vocal cord is very rare. We report five cases diagnosed at our voice clinic during 18 months-period from July 2016 to December 2017. All the five patients presented with hoarseness and the laryngoscopy examination detected a pink mass at the vocal edge with the histopathology indicating hemangioma. Direct laryngoscopy with laryngeal carbon dioxide (CO2) laser microscopic surgery was performed uneventfully and no recurrence was found. We suggest that Microscopic Laser Laryngoscopy (CO2) is the treatment option of vocal fold hemangioma with no intraoperative massive bleeding.
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  • 文章类型: Journal Article
    UNASSIGNED: The recent introduction of 445 nm blue laser to office-based laryngology presents potential advantages. These include a desirable combination of cutting and photoangiolytic qualities and a lightweight, shock-resistant design. Despite its increasing use, current evidence is limited to experimental data and case reports.
    UNASSIGNED: The authors present a case series and overview of office blue laser transnasal flexible laser surgery (TNFLS), considering indications, patient selection, safety, technique, and surgical outcomes. We also review the safety and relevance of TNFLS to the ongoing coronavirus pandemic.
    UNASSIGNED: Retrospective case series and narrative review. Our primary outcome measure was preoperative and postoperative Voice Handicap Index (VHI-10) score. Complications were documented by nature and severity.
    UNASSIGNED: Thirty-six cases of office blue laser TNFLS were performed. A statistically significant improvement in VHI-10 score was demonstrated in cases of recurrent respiratory papillomatosis (RRP) and benign laryngeal lesions causing dysphonia (P < 0.01 and 0.045). Blue laser also proved effective in assisting office biopsy procedures. A minor and self-limiting complication was reported.
    UNASSIGNED: Office blue laser TNFLS is safe and effective in the treatment of RRP and a range of benign laryngeal lesions. Future research should compare the efficacy and safety of blue laser with potassium titanyl phosphate laser in office-based treatment of these conditions. Further assessment of the cutting qualities of blue laser, initially in the theater environment, is necessary to refine our understanding of future applications.
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  • 文章类型: Journal Article
    Objectives: To describe the evolution of day-case success rate over the years and to identify predictive factors for prolonged hospitalization or readmissions. Methods: Retrospective review of all consecutive day-case holmium laser enucleation of the prostate (HoLEP) performed by a single surgeon between January 2013 and February 2019 using a prospective database. Day-case success was defined as discharge within less than 12 hours from admission without any readmission within 48 hours after discharge. Protocol for day-case treatment included systematic bladder catheter insertion with continuous irrigation for ∼2 hours and catheter removal on postoperative day 1. Patients were reached by phone on postoperative day 1 to ensure voiding. For the descriptive statistics, an analysis of variance was performed. Univariate and multivariate analyses were used to identify risk factors. Results: A total of 266 patients were retrieved and dispatched as follows: group 1 (n = 88) from January 2013 to July 2015, group 2 (n = 89) from August 2015 to June 2017, and group 3 (n = 89) from July 2017 to February 2019. The overall success rate was 80.5% (214/266) over the study period. It significantly improved over time from 70% in group 1 to 84% in group 2 and 87% in group 3 (p = 0.014). In the meantime, the operating time and the total energy delivered to the tissue decreased from 77 minutes in the first group to 60.4 minutes in the second group and 55.4 minutes in the third group (p < 0.001), and from 95.2 kJ in the first group to 84 kJ in the second group and 77.9 kJ in the third group (p = 0.041). On multivariate analysis, the only risk factor significantly associated with day-case failure was prostate volume greater than 90 cc (odds ratio = 2.041, p = 0.047). Conclusion: Day-case HoLEP is a reliable and safe procedure with a high success rate. The surgeon\'s experience seems to be crucial to improve perioperative outcomes, but prostate volume greater than 90 cc remains associated with higher failure rates.
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  • 文章类型: Journal Article
    OBJECTIVE: To provide the first large single-operator case series of patients who undergo \"en bloc\" thulium laser enucleation of the prostate (ThuLEP) and to demonstrate an improvement in enucleation efficacy with experience.
    METHODS: We prospectively evaluated a cohort of patients with symptomatic benign prostatic hyperplasia (BPH) who underwent \"en bloc\" ThuLEP between May 2015 and November 2017. Association between dependent variables (delivered energy and operating time) and independent variables (adenoma volume and experience) were estimated with regression analysis. The experience was calculated as the time interval between the date of the first operation of the series and the date of the operation being considered.
    RESULTS: A total of 100 patients were registered for the study. Median operative time was 56.5 min (interquartile range [IQR]: 40-85 min). Median enucleation time was 17.4 min (IQR: 15-21.5 min). Median enucleation index (enucleation time per adenoma gram) was 0.3 min/g (0.2-0.3 min/g). The overall operative time is not influenced by experience, but we registered a significant trend towards a reduction in the total amount of energy delivered energy normalized per adenoma gram (p = 0.0148).
    CONCLUSIONS: We believe that further attention is needed for these new \"en bloc\" prostatic enucleation techniques, which can facilitate some surgical steps, leading to a widespread use of laser technology for BPH surgical treatment.
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  • 文章类型: Journal Article
    Pyogenic granuloma is a non-neoplastic, exuberant, reactive lesion seen in response to local irritation or trauma caused by dental calculus, bacterial plaque, caries and restorations, with a strong predilection for the gingiva. It is among the frequently encountered oral lesions, occurring at a challenging oral site, the gingiva. Herein, we report a 71-year-old medically compromised Caucasian female who presented with a relatively large lobulated pyogenic granuloma on the buccal gingiva of the maxillary molar-premolar region. Total surgical excision was performed with an 840nm diode laser followed by the placement of hyaluronate gel and relevant periodontal dressing. Two weeks after surgical excision, complete healing was observed, but patient denied replacement of dental restoration. After 4 months of follow-up, an overall reduction of associated teeth mobility was also observed, with a minor recurrence in gingival inflammation. The objective of this report is to briefly review clinical, radiographic and histological findings of pyogenic granuloma along with a detailed discussion on its management through a diode laser.
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  • 文章类型: Journal Article
    Vascular anomalies of the head and neck are common lesions usually associated with functional and/or aesthetic limitations. The aim of the present paper was to report a case series of oral vascular malformations treated with Nd:YAG laser photocoagulation, highlighting the clinical evolution and post-surgical complications. Fifteen patients diagnosed with oral vascular malformations were treated with Nd:YAG laser followed by three sessions of biostimulation. None of the patients presented post-surgical pain, but 6 of 15 patients (40%) experienced minimal post-surgical complications. All cases presented complete resolution of the lesions after laser treatment. More importantly, 12 out of 15 (80%) resolved after a single session. Low morbidity, minimal patient discomfort, and satisfactory aesthetic results point Nd:YAG laser photocoagulation as a promising option for the management of benign oral vascular lesions.
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  • 文章类型: Case Reports
    This case report demonstrates the ablation of a dermal nevus using a diode laser in the esthetically very demanding facial area of the nasal tip. The clinical outcome shows good results and a high level of patient satisfaction. Due to effective wound granulation and healing, elaborate skin grafts could be avoided. The application of the contact laser ensures safe treatment in highly perfused areas thanks to haptic feedback and good coagulative effect. The method should therefore be considered as an alternative to other ablative procedures for benign lesions in the facial area.
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