下甲介粘膜レーザー手術 (表層焼灼術) -術後7年の遠隔成績-

抄録

The long-term (7 years) effects of CO₂ laser surgery in 68 patients with perennial allergic rhinitis were obtained from answers to a questionnaire. Subjectively, excellent or good general improvement was obtained in 57% of patients even more than 7years after the surgery. Relief (no or mild symptoms) from sneezing attacks, nasal discharge, and nasal blockage were noted in 87%, 66%, and 69%, respectively. The mechanism of CO₂ laser surgery was investigated by using rhinomanometry, laser-doppler velocimetry, and by measuring the ECP (eosinophil cationic protein) of the nasal lavage fluid. The amount of ECP was significantly decreased after surgery in all patients, especially in those with a very good response to surgery. Nasal airway resistance was not altered by the surgery; however, its response to antigen provocation was significantly decreased. Nasal blood flow in patients with nasal allergy was less than that in normal subject, but the difference was decreased by laser treatment. These results suggest that laser surgery is effective for treatment of nasal allergy via the following mechanism: laser injury vaporizes the nasal mucosa to a limited depth secondarily producing a permanent scarred layer. This scar persists for as long as 5 years, preventing allergic reactions and inhibiting the release of chemical mediators. Evidence from our basic and clinical studies supports the conclusion that laser surgery is an effective and functional treatment for nasal allergy.