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Laryngorhinootologie 2003; 82: 114-143
DOI: 10.1055/s-2003-38924
© Georg Thieme Verlag Stuttgart · New York

6 Laser im oberen Aerodigestivtrakt bei bösartigen Erkrankungen

P.  Ambrosch1
  • 1Direktorin der Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie der Christian-Albrechts-Universität zu Kiel
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Publikationsverlauf

Publikationsdatum:
28. April 2003 (online)

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Zusammenfassung

Die transorale Lasermikrochirurgie entwickelte sich in den letzten Jahren zu einer Operationsmethode, die den minimal-invasiven Zugangsweg mit den besonderen Vorzügen des Lasers - der chirurgischen Präzision, der leichten Steuerbarkeit, der optimierten Gewebewirkung und der berührungslosen Vorgehensweise - in sich vereinigt. Die Prinzipien der lasermikrochirurgischen Resektion von Mundhöhlen-, Oro-, Hypopharynx- und Larynxkarzinomen werden beschrieben und die onkologischen und funktionellen Ergebnisse der Lasermikrochirurgie den Ergebnissen der konkurrierenden Standardtherapieverfahren gegenübergestellt. Die Vorteile der Lasermikrochirurgie in der Behandlung früher Stimmlippenkarzinome sind weithin anerkannt. Der Stellenwert der Laserchirurgie in der Behandlung von Stimmlippenkarzinomen mit Bewegungseinschränkung oder Fixation der Stimmlippe ist noch nicht abschließend zu beurteilen. Nach den bisher vorliegenden Ergebnissen kann in etwa 70 % der Fälle mit der primären Therapie lokale Tumorfreiheit mit funktionsfähigem Restkehlkopf erzielt werden. Beim Larynxkarzinomrezidiv nach primärer Strahlentherapie ist die Lasermikrochirurgie den klassischen Larynxteilresektionen in onkologischer Hinsicht vergleichbar, sie hat jedoch weniger Komplikationen. Beim frühen und beim mäßig weit fortgeschrittenen supraglottischen Karzinom ist die Lasermikrochirurgie der klassischen Kehlkopfteilresektion im Hinblick auf die lokale Kontrolle und das Überleben vergleichbar. Gemessen am Organerhalt ist sie den klassischen Teilresektionen vergleichbar, der primären Strahlentherapie jedoch überlegen. Durch die Mikrochirurgie können funktionell wichtige Strukturen geschont werden, so dass eine frühe Schluckrehabilitation unter Vermeidung der Tracheotomie möglich ist. Auch Karzinome des Hypopharynx können unter Organ- und Funktionserhalt mit guten onkologischen Ergebnissen mit dem Laser operiert werden. Verglichen mit der Standardtherapie und neueren Protokollen mit dem Ziel des Organerhalts (neoadjuvante Chemotherapie und Radiotherapie, simultane Chemo-Radiotherapie) stellt die Lasermikrochirurgie eine therapeutische Alternative dar. Bei Mundhöhlen- und Oropharynxkarzinomen bedeutet der en- oder transorale Zugangsweg durch den Verzicht auf Pharyngotomie, Unterkieferspaltung bzw. Unterkieferteilresektion und Tracheotomie weit weniger Morbidität für den Patienten. Auch große Defekte in Mundhöhle und Oropharynx müssen nicht plastisch verschlossen werden. Der Verzicht auf eine plastische Deckung muss für die postoperative Schluck- und Sprechfunktion nicht nachteilig sein.

Schlüsselwörter

CO2-Lasermikrochirurgie - Plattenepithelkarzinom - Oberer Aerodigestivtrakt - Larynx - Hypopharynx - Oropharynx - Mundhöhle

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Prof. Dr. Petra Ambrosch

Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie der Christian-Albrechts-Universität zu Kiel

Arnold-Heller-Straße 14 · 24105 Kiel ·

eMail: ambrosch@hno.uni-kiel.de