经口CO?激光切除舌根囊肿的经验及疗效探讨

Experience and Efficacy of Transoral CO? Laser Resection for Lingual Cysts

摘要:

目的 探讨支撑喉镜下经口CO?激光切除舌根部囊肿的临床疗效、并发症及复发情况,为经口激光治疗舌根部囊肿的规范化应用提供循证依据。 方法 回顾性分析2022年1月至2025年6月于山东省耳鼻喉医院咽喉科接受经口CO?激光切除治疗的34例舌根部囊肿患者临床资料。所有患者均在全身麻醉经口气管插管下接受支撑喉镜下CO?激光切除术,术中遵循标记切除范围、主动减压、完整切除囊壁基底、即时止血等关键技术要点,术后观察恢复情况,定期随访评估疗效及复发情况。结果 34例患者均顺利完成手术,无术中改行开放手术者。术后病理证实均为良性囊性病变,以复层鳞状上皮衬里最为常见。术后患者恢复良好,均未鼻饲饮食,无术中或术后大出血、咽瘘、呼吸困难等并发症,无气管切开病例。术后随访10～36个月,总体一期成功率为91.2%(31/34),复发率8.8%(3/34)。复发的3例均为外院术后复发病例,本组初治患者29例无一例复发。结论 支撑喉镜下经口CO?激光切除舌根囊肿微创、安全、有效,术后恢复快、并发症少。术中注意囊肿边界标记、主动减压及基底部完整切除等操作细节,可显著提高一期治愈率、降低复发。对于初治的舌根良性囊肿,该术式可作为首选微创治疗方案。

Abstract:

Objective To investigate the clinical efficacy, complications, and recurrence of transoral CO? laser resection of lingual cysts under suspension laryngoscopy, and to provide evidence-based support for the standardized application of transoral laser therapy in lingual cysts. Methods A retrospective analysis was conducted on 34 patients with lingual cysts who underwent transoral CO? laser resection at the Department of Laryngology, Shandong Provincial ENT Hospital from January 2022 to June 2025. All patients underwent CO? laser resection under suspension laryngoscopy with general anesthesia and orotracheal intubation. Key technical steps included marking the resection margin, active decompression for large cysts, complete excision of the base, and immediate hemostasis. Perioperative recovery was observed, and regular follow-up was performed to evaluate efficacy and recurrence. Results The procedure was successfully performed in all 34 patients, with no intraoperative conversion to an open approach. Postoperative pathology confirmed benign cystic lesions, with stratified squamous epithelium being the most common lining. Postoperative recovery was favorable in all patients; no nasogastric feeding was required, and no complications such as intraoperative or postoperative hemorrhage, pharyngeal fistula, respiratory distress, or tracheotomy occurred. Follow-up ranged from 10 to 36 months. The overall primary success rate was 91.2% (31/34), with a recurrence rate of 8.8% (3/34). All 3 recurrent cases were previously treated at other hospitals, while none of the 29 primary treatment cases in our series recurred. Conclusion Transoral CO? laser resection of lingual cysts under suspension laryngoscopy is minimally invasive, safe, and effective, with rapid postoperative recovery and few complications. Attention to technical details such as cyst margin marking, active decompression, and complete excision of the cyst base can significantly improve the primary cure rate and reduce recurrence. This approach may serve as the preferred minimally invasive treatment for primary benign lingual cysts.