Steroid injection for Reinke's edema using fiberoptic laryngeal surgery

OBJECTIVE: Since 1990, we have performed steroid injections into the vocal fold under topical anesthesia using fiberoptic laryngeal surgery (FLS) in an outpatient clinic. The aim of this study was to retrospectively assess the usefulness of this treatment method in 44 patients with mild Reinke's edema. MATERIAL AND METHODS: Using fiberoptic monitoring of the larynx, a curved injection needle was inserted via the oral cavity and triamcinolone acetonide was injected into Reinke's space of the bilateral vocal fold. RESULTS: Remission or improvement was observed in almost all patients in terms of both patients' self-rating of hoarseness and endoscopic vocal fold findings The maximum phonation time was a mean of 9.0 s before operation and 11.4 safter operation, and this increase was significant (p < 0.01). Voice pitch also improved, from 168 to 181 Hz, in female patients, and this increase was also significant (p < 0.05). CONCLUSION: Steroid injection is considered to be useful for treating mild Reinke's edema.     

纤维喉镜下Nd:YAG激光治疗760例声带息肉和小结的疗效分析

目的 评价纤维喉镜下激光治疗声带息肉和声带小结疗效。方法 对随访2年以上的760例声带息肉（516例）和小结（224例）病人进行了总结、分析。结果 声带息肉和小结一次性治愈率分别为96％、99％，末彻底治愈的20例声带息肉病人、3例声小结病人经再次激光治疗后痊愈。结论 纤维喉镜下引导导激光是治疗声带息肉和小结的有效方法，具有痛苦小、反应轻、恢复快、复发率低的优点。     

可视支撑喉内镜下喉功能性手术

目的探讨可视支撑喉内镜下喉功能性手术的可行性。方法喉部良性疾病患者160例,随机等分为两组,即可视支撑喉内镜组（研究组）80例,传统显微镜支撑喉镜手术组（对照组）80例。手术显微器械相同,手术由同一人完成。对两组的手术时间、住院时间、发音恢复时间、手术常见并发症及疗效等方面进行统计分析。结果手术时间：研究组（11.38±4.65）min,对照组（20.72±3.23）min,二者比较差异具有统计学意义（P<0.01）。其他手术疗效、平均住院日及手术并发症等均无统计学意义（P>0.05）。结论可视支撑喉内镜功能性手术治疗结果和手术并发症与传统的显微镜功能性手术没有差别,而在手术时间、操作难度等方面具有优势,可视支撑喉内镜功能性手术是可行的。     

Management of vocal fold lesions in difficult laryngeal exposure patients in phonomicrosurgery

Objectives

Endolaryngeal microsurgery using a direct laryngoscope is a well-established procedure in phonosurgery. Adequate laryngeal exposure is essential, but in some cases sufficient view of the glottis cannot be obtained, leading to treatment failure. This study reports how to manage vocal fold lesions in difficult laryngeal exposure (DLE) cases.

Methods

From 2003 to 2009, 212 patients underwent endolaryngeal microsurgery at Kyoto Medical Center and Kyoto University Hospital. Phonomicrosurgery was performed under sniffing (Boyce-Jackson) position with triangular shaped laryngoscope for laryngeal exposure. However, in DLE cases, the posture and laryngoscope were modified as needed to adequately expose the lesion. Fiberoptic laryngeal surgery (FLS) with local anesthesia was also used for the most difficult cases.

Results

The number of the patients with DLE was 14 (6.6%). Endolaryngeal microsurgery was possible in DLE cases by selecting the appropriate posture and laryngoscope. However, the procedure could not be completed in two patients with an anterior web and a vocal fold cyst, both of which required a subsequent revision procedure. Fiberoptic laryngeal surgery with topical anesthesia was a feasible alternative for these cases.

Conclusions

Phonosurgery was possible even in DLE cases. It is important to modify the setup of direct laryngoscopy as needed to obtain adequate exposure. Fiberoptic surgery may also be used in certain difficult cases.     

喉返神经修复术及非喉返神经修复术治疗声带麻痹

目的 探讨喉返神经修复术及非喉返神经修复术这两种不同术式治疗声带麻痹的疗效。方法 ①单侧声带麻痹21例, 其中采用喉返神经修复术(喉返神经减压术、颈袢神经与喉返神经吻合术、颈袢神经肌肉蒂环杓侧肌移植术)15例, 采用非喉返神经修复术(声带自体脂肪注射术、自体软骨Ⅰ型甲状软骨成形术)6例;②双侧声带麻痹16例, 其中采用喉返神经修复术(喉返神经减压术、颈袢神经肌肉蒂环杓后肌移植术)6例, 采用非喉返神经修复术(声带外移术、内镜下杓状软骨切除术)10例。治疗前后以电子喉镜、频闪喉镜、声音评估等评价手术疗效。结果 ①单侧喉返神经麻痹患者中喉返神经修复组15例, 术后术侧声带活动不同程度改善, 发音时声带突明显内收, 声带振动及黏膜波均恢复对称性, 声门闭合良好, 手术前后的最大声时为(5.51±1.05)s和(12.10±1.41)s, 差异有统计学意义(P<0.01);非喉返神经修复术术后声带均不同程度内移, 声嘶症状改善, 但声带均无运动, 手术前后的最大声时为(5.47±0.45)s和(11.83±1.47)s, 差异有统计学意义(P<0.01)。神经修复组和非神经修复组术后最大声时比较, 差异无显著性意义(P>0.05);②双侧喉返神经麻痹患者中喉返神经修复术6例中, 术后呼吸困难缓解及声带外展部分恢复4例;非神经修复术10例术后呼吸困难改善;神经修复组术后拔管率为66.7%, 非神经修复组术后拔管率为100%;Fisher精确概率法比较两组术后拔管率, 差异无统计学意义(P>0.05)。结论 对于单侧声带麻痹, 喉返神经修复术及非喉返神经修复术疗效相当, 前者的远期疗效更佳。对于双侧声带麻痹, 非喉返神经修复术疗效更佳, 但喉返神经修复术不影响患者的发音功能。选择喉返神经修复术或非喉返神经修复术治疗声带麻痹, 需要医师根据自身的专业知识及技能、患者的身体状况及需求, 作出慎重的决定, 以取得可靠的疗效。     

表面麻醉支撑喉镜喉显微手术治疗声带良性病变

目的:探讨喉显微手术治疗声带良性病变的效果及麻醉选择。方法:手术在1%丁卡因表面麻醉支撑喉镜下进行,采用普通手术显微镜连接300mm焦距镜头观察病变。结果:872例中声带息肉353例,声带小结438例,声带囊肿81例,851例完成手术,697例1次治愈,总有效率为96.9%。结论:青、壮年患者,无明显心血管疾病,可选择表面麻醉手术,表面麻醉并发症少,恢复快,支撑喉镜下显微手术清除病变彻底。     

支撑喉镜和纤维喉镜下声带息肉切除术疗效分析

目的　比较支撑喉镜和纤维喉镜下切除声带息肉的临床疗效。方法　选取2014年2月～2015年6月在我院行声带息肉切除的94例患者为研究对象,随机分为支撑喉镜组（51例）和纤维喉镜组（43例）,比较两组患者手术时间、出血量、住院时间、术后疗效、并发症及医疗费用等。结果  支撑喉镜组手术时间及术中出血量分别为（22.5±7.3）min 及（5.8±1.2）ml,纤维喉镜组分别为（29.8±7.9）min及（14.6±2.5）ml;支撑喉镜组有效率为96.08%,纤维喉镜组为81.40%;支撑喉镜组并发症发生率为5.88%,纤维喉镜组为18.60%;支撑喉镜组医疗费用为（0.71±0.12）万元,纤维喉镜组为（0.35±0.08）万元。住院时间两组比较无统计学意义。结论　支撑喉镜下切除声带息肉在手术时间、术中出血量、疗效以及并发症发生率等方面均优于纤维喉镜。     

Return of vocal cord movement: an independent predictor of response to nonsurgical management of laryngeal cancers

OBJECTIVE: To determine whether return of vocal cord function after treatment of T2b/T3 laryngeal carcinoma is an independent prognostic factor for locoregional recurrence. STUDY DESIGN: A retrospective review of patients treated with radiation +/- chemotherapy between 2000 and 2005 for T2 with vocal cord paresis and T3 laryngeal carcinoma was conducted. METHODS: Only those patients obtained from the tumor registry with pre-and posttreatment video stroboscopies were included. Patients' charts were reviewed for local and regional recurrence after treatment. Fisher's exact test was used to determine significant association between recurrence and possible risk factors. RESULTS: Fourteen patients met the inclusion criterion. Six patients had T2 lesions with vocal cord paresis, and eight patients had T3 lesions. Fifty percent of patients with T2 and 75% of patients with T3 lesions had return of vocal cord function after treatment. Five of 14 patients did not have return of vocal cord function, and of these, 100% had locoregional recurrence. Of the nine patients who had return of vocal cord movement, none of the patients had recurrence. The proportion of recurrence was significantly higher for those whose vocal function did not return compared with the patients whose vocal function returned (100% vs. 0%, P < .01). CONCLUSION: The immobile vocal cord is associated with a worse prognosis and is therefore factored into the American Joint Commission on Cancer staging for laryngeal tumors. We show that vocal cord immobility is an independent prognostic factor of recurrence even after treatment and can predict treatment failure in T2 and T3 lesions of the larynx.     

全麻甲状腺手术中的喉返神经实时监控

目的评价术中实时监控技术在预防喉返神经医源性损伤中的实际意义和应用前景.方法自2002年11月至2005年5月在40例全麻甲状腺手术中对喉返神经功能进行术中实时监控.全部采用气管插管式电极,同步进行全麻与术中监控.在7例腺叶切除手术中主动探测解剖喉返神经,搜寻探测到喉返神经5例,其他类型的手术中均没有解剖暴露喉返神经.结果39例患者术后喉返神经功能保持完好,1例术中即发生左侧喉返神经麻痹.40例均满意记录到声带非同步性自发喉肌肌电图波,刺激显露和探测到的12例喉返神经,均能诱发喉肌同步肌电图反应波.最小刺激电流强度阈值为0.08～0.35 mA,平均最小电刺激阈值为0.25 mA,适宜刺激电流范围为0.2～1.0 mA.结论喉返神经术中实时监控技术具有灵敏度高、准确性强和稳定性好的特点,可以在术中提供神经受刺激的同步信息,起到早期预警的作用.该技术的应用可以减少医源性喉返神经损伤,预防严重并发症的发生.术中可以不用预先解剖喉返神经,提高手术安全性.     

支撑喉内镜联合喉吸切割系统在喉微创手术中的应用观察

目的：观察支撑喉内镜联合喉吸切割动力系统在喉良性增生性病变切除术中的应用效果。方法回顾性分析2009年12月～2013年8月本院在支撑喉内镜下联合使用美敦力喉吸切割动力系统完成的喉良性增生性病变切除术178例,总结其应用效果。所有患者于术后均适当禁声,并予以雾化吸入及中药甘桔冰梅片口服等综合治疗。结果本术式操作简便,视野清晰精确,所有手术均一次成功,治愈率高达95.5%,仅1例声带白斑患者2个月后出现病变复发并发生癌变,改行一侧声带激光切除术,其他均痊愈。结论支撑喉内镜联合喉吸切割系统切除喉的良性增生性病变,具有视野清晰、无盲区、操作便捷、精确度高、并发症少、疗效肯定等优点,值得临床推广。