目的:我们的目的是系统回顾有关在喉经口激光显微手术(TOLMS)中最佳使用CO2激光的围手术期实践的文献,注重安全。
方法:对Medline索引的出版物的系统回顾,Embase,和EBM评论-进行Cochrane中央对照试验注册,评估了在喉TOLMS中使用CO2激光的围手术期策略。
方法:由2名独立研究人员使用Covidence软件在2步过程中评估从搜索策略获得的记录是否合格。
结果:在2143条确定的记录中,103人被纳入本研究。大多数研究(n=25)集中在肿瘤切除术中使用CO2激光,虽然20个讨论了声带麻痹的治疗,16讨论了小儿或先天性病变的治疗,11详细的良性病变的管理,31项研究解决了其他手术适应症。安全CO2TOLMS的策略在研究中高度异质,包括术前措施(即,与环境有关,员工准备,患者保护,和通风),术中预防措施(即,保护非目标结构,技术考虑,局部和全身药物),和术后策略(即,与气道保护有关,口服摄入,声乐休息,住院时间,药物治疗方案,和顾问跟进)。
结论:本研究提供的结果可用作指导跨机构创建激光安全协议的框架,指导质量改进举措,开展模拟训练活动,并作为促进住院医师教学和技能评估的工具。
OBJECTIVE: We aim to systematically review the literature addressing perioperative practices for optimal use of the CO2 laser in laryngeal transoral laser microsurgery (TOLMS), with a focus on safety.
METHODS: A systematic review of publications indexed in Medline, Embase, and EBM reviews-Cochrane Central Register of Controlled Trials which evaluated perioperative strategies for the use of CO2 laser in laryngeal TOLMS was conducted.
METHODS: Records obtained from the search strategy were assessed for eligibility in a 2-step process by 2 independent researchers using the Covidence software.
RESULTS: Among 2143 identified records, 103 were included in this study. The majority of studies (n = 25) focused on the use of the CO2 laser in oncologic resection, while 20 addressed the treatment of vocal cord paralysis, 16 discussed the treatment of pediatric or congenital pathologies, 11 detailed the management of benign lesions, and 31 studies tackled other surgical indications. Strategies for safe CO2 TOLMS were highly heterogeneous across studies and included preoperative measures (ie, related to the environment, staff preparation, patient protection, and ventilation), intraoperative precautions (ie, protection of nontarget structures, technical considerations, topical and systemic medications), and postoperative strategies (ie, related to airway protection, oral intake, vocal rest, hospitalization duration, drug regimen, and consultant follow-up).
CONCLUSIONS: The results provided in this study can be used as a framework to guide the creation of laser safety protocols across institutions, guide quality improvement initiatives, the development of simulation training activities, and as a tool to facilitate resident teaching and skill assessment.