陈旧性闭合性喉气管断裂伤的手术治疗

严重的颈部闭合性损伤可发生喉气管断裂，伤后出现呼吸困难，临床上多实行气管切开术治疗，此时患者可能伴有重要器官外伤，忽略或条件有限未及时处理喉气管伤，遗留喉气管狭窄甚至闭锁，病程长久，很难治疗。我科自2001年11月至2005年9月共治疗陈旧性颈部闭合性喉气管断裂伤4例，现报告如下。     

成功救治急性闭合性喉气管食管断裂1例

我科近期成功救治1例因颈部外伤致急性闭合性喉气管完全断离、食管大部断裂病人，报道如下。     

严重颈部闭合性损伤致喉气管断裂的救治体会（附8例报告）

从１９７６年１２月至１９９６年９月，我们救治了８例严重闭合性损伤致喉气管断裂的患者，男６例，妇２例，年龄１３￣３６岁，平均２４岁。结果２例死亡，１例死于出血窒息，另１例尚未来得及手术而死亡；１全甸救治不当发生气管狭窄而需进一步整复，其余５例恢复了喉的功能。强调在修复中应最大限度地保留破碎的软骨膜、软骨和粘膜。本文重点讨论了颈部闭合性损伤致喉气管断裂的发病机理，临床特点及急救原则。     

严重颈部闭合性损伤致喉气管断裂的救治体会(附8例报告)

从1976年12月到1996年9月,我们救治了8例严重闭合性损伤致喉气管断裂的患者,男6例,女2例,年龄13～36岁,平均24岁。结果2例死亡,1例死于出血窒息,另1例尚未来得及手术而死亡;1例因救治不当发生喉气管狭窄而需进一步整复,其余5例恢复了喉的功能。强调在修复术中应最大限度地保留破碎的软骨膜、软骨和粘膜。本文重点讨论严重颈部闭合性损伤致喉气管断裂的发病机理、临床特点及急救原则。     

严重喉气管外伤的一期整复手术治疗

喉气管外伤分为闭合性和开放性。轻度的损伤一般采用简单的清创缝合或密切观察下抗炎、消肿治疗。严重者指外伤造成急性喉梗阻、进行性皮下气肿、喉气管软骨塌陷及粉碎性骨折、喉气管断裂等需紧急气管切开者，应即刻手术探查，这样既避免或减少了喉狭窄的发生，又能彻查病情，避免误诊而延误治疗。我们总结了32例严重喉气管外伤的一期整复手术治疗的治疗经验，报道如下。     

闭合性喉气管损伤手术指征与手术时机的探讨

目的 探讨闭合性喉气管损伤的手术指征和手术时机,减少喉气管狭窄形成.方法 回顾性分析1988年1月～2008年1月来我科就诊的33例闭合性喉气管损伤患者的临床资料,其中7例为急性损伤,26例为因闭合性损伤导致的不同程度的喉气管狭窄,对所有患者的相关问题进行分析及讨论.结果 7例急性损伤中,6例在伤后24 h内行喉气管探...     

闭合性喉气管损伤诊断与治疗探讨

目的探讨进一步提高闭合性喉气管损伤诊断与治疗水平的措施。方法分析32例闭合性喉气管损伤患者的临床资料,对相关问题进行讨论。结果32例闭合性喉气管损伤病例,2例死亡,1例因救治不当发生喉气管狭窄而需进一步整复,其余29例恢复了喉的功能。结论对喉气管外伤准确分度,在修复术中最大限度地保留破碎的软骨膜、软骨和粘膜是提高近期疗效、预防后期喉狭窄的关键。     

喉科学

20050069闭合性喉气管损伤诊断与治疗探讨/ 路学美…//中国耳鼻咽喉头颈外科.2004,11(3) .165～166 目的:探讨进一步提高闭合性喉气管损伤诊断与 治疗水平的措施。方法:分析32例闭合性喉气管损 伤患者的临床资料,对相关问题进行讨论。结果:32 例闭合性喉气管损伤病例,2例死亡,1例因救治不当 发生喉气管狭窄而需进一步整复,其余29例恢复了 喉的功能。结论:对喉气管外伤准确分度,在修复术 中最大限度地保留破碎的软骨膜、软骨和黏膜是提高 近期疗效、预防后期喉狭窄的关键。参4(蔡超) 20050070声带注射得保松治疗慢性肥厚性喉 炎/黄益灯…//…     

一期整复手术治疗喉气管外伤45例

目的通过分析一期整复手术对喉气管外伤患者喉气管功能恢复的影响，探讨喉气管外伤合理的救治方法。方法对45例喉气管外伤患者均施行一期喉气管探查术，其中闭合性喉气管外伤15例，开放性喉气管外伤30例。结果术后顺利拔管40例，其中仍有声嘶12例；未能拔管4例，术后均发生喉狭窄，其中2例经二次手术喉内放置硅胶管扩张后拔管，2例喉腔肉芽生长反复多次钳取、激光切除，致瘢痕狭窄再行手术，延迟拔管；1例吻颈患者在行喉气管整复术后放弃治疗，2?d后死亡。结论在处理喉气管外伤中应尽可能一期重建喉气管的结构，保留、恢复患者的喉气管功能，早期正确处理是防止喉狭窄的关键。     

闭合性喉气管破裂伤四例报告

闭合性喉气管破裂伤四例报告陈崇喜颈部闭合性创伤致喉气管破裂，临床偶有所见，对其进行早期诊断和处理是非常重要的。现将我院收治的４例报告如下。１病例介绍例１男，２６岁。１９９３年８月８日晚骑摩托车时颈部撞到铁管上，当即出现颈前部疼痛，声嘶、阵咳、咯血（少...     

累及喉气管的晚期甲状腺癌一期手术整复

目的：探讨晚期甲状腺癌累及喉、气管时的一期手术整复方法。方法：对18例存在喉气管受累的晚期甲状腺癌患者进行一期肿瘤全切及喉气管整复，其中7例喉受累患者全喉切除3例，喉部分切除4例；18例颈段气管受累患者中，8例直接切除肿瘤，10例切除受累气管壁后，修复方法包括：拉扰缝合1例，端端吻合3例、带蒂胸锁乳突肌骨膜瓣2例、岛状胸大肌肌皮瓣3例和颈部皮瓣1例。结果：住院期间肿瘤复发死亡1例。除3例全喉切除患者外，14例成功保留喉功能，其中拔除气管套管8例，堵管2例，继续带管4例。结论：对于累及喉气管的晚期甲状腺癌采用一期手术切除并整复不仅切实可行，而且可以提高此类患者的治愈机会，改善生活质量。     

咽喉部尖锐湿疣的诊断方法探讨

目的：探讨咽喉部尖锐湿疣的诊断方法。方法：通过病史与临床分析，并应用病理组织学、免疫组化染色和ＰＣＲ等方法检测致病原。结果：正确诊断了６例咽喉部尖锐湿疣。结论：病史、临床表现、病理组织学检查、ＨＰＶ－Ａｇ免疫组化染色和ＰＣＲ检测组织中ＨＰＶ相结合，是目前诊断咽喉部尖锐湿疣的有效方法。     

Treatment of a thyroid neoplasm infiltrating the respiratory-digestive tracts

From 1992 to 1999, 58 thyroid gland operations (41 female and 17 male) were performed in ENT Department of the District Hospital in Rzeszów. In 14 (21.4%) cases (9 female and 5 male) thyroid surgery was done for malignant disorders: papillary carcinoma in 11 (79%) patients, follicular carcinoma in 2 patients and medullary carcinoma in 1 patient. There were neck metastases in 9/14 (64.4%) patients. In 3 cases with papillary carcinoma (all with neck metastases) aerodigestive tract was invaded. One patient had neoplasmatic invasion of the larynx and trachea, one patient had invasion of larynx et pharynx and in one patient tumour invaded the esophageal wall. In those patients radical surgery was done: total thyroidectomy with total laryngectomy and radical neck dissection (2 patients) and subtotal thyroidectomy with conservative neck dissection (1 patient). External beam irradiation and radioactive iodine 131 treatment followed surgery. Two patients are still alive 6 years after the treatment free of disease, and 1 patient died of unrelated causes 3 months after the surgery. Symptoms, diagnostic evaluation and treatment of thyroid papillary carcinoma invading the aerodigestive tract are detailed in paper.     

Malignant fibrous histiocytomas of larynx]

OBJECTIVE: To explore the histopathology, diagnosis and treatment of malignant fibrous histiocytomas (MFH) of larynx. METHODS: The clinical and pathologic features of 9 cases with MFH of larynx were reviewed retrospectively. RESULTS: All the 9 cases with MFH of larynx were adults (the age ranged from 43 to 87 years; average 56 years); 8 were men and 1 woman. The tumor of eight cases originated in glottic area and 1 case occurred in supraglottic area. The histological diagnosis was difficult, so the immunohistochemical studies in 5 cases were examined. Because surgical resection was a mainly treatment, seven patients underwent total laryngectomy and 2 cases underwent frontal partial laryngectomy. Six patients were followed up for more than 3 years and no patient died of MFH after surgical resection. CONCLUSION: The diagnosis of MFH of larynx was sometimes difficult and immunohistochemistry could be helpful. The mainly treatment of MFH of larynx was surgical resection by total laryngectomy or partial laryngectomy.     

Malignant fibrous histiocytoma of the head and neck. A report of 12 cases

The clinical and pathologic features of 12 cases of malignant fibrous histiocytoma of the head and neck were studied. These tumors occurred in seven men and five women ranging in age from 21 to 75 years (average, 55 years). The sinonasal tract was the most common site (four cases), followed by the parotid area (two cases), oral cavity (two cases), soft tissues of the neck (two cases), mandible (one case), and larynx (one case). Pathologically, 11 of the tumors were subclassified as storiform-pleomorphic and one as inflammatory. All were treated initially with surgery with or without postoperative irradiation. Five (42%) of the patients experienced local recurrences, three (25%) developed distant metastases (especially to the lungs), and five (42%) died of their disease, all of the latter occurring within two years of diagnosis. No patient developed bona fide cervical lymph node metastasis, although one did have a positive paraparotid node as a result of direct extension from an adjacent tumor.     

Carcinomas of the thyroid gland invading larynx and trachea

Twenty-nine patients with a thyroid carcinoma invading the larynx and trachea were treated over a 25-yr period. Eight patients had invasion of the walls of the trachea or larynx and 21 had invasion into the lumen. Of the 15 patients who underwent limited surgery, i.e. total thyroidectomy, tracheostomy and neck dissection, 8 had intraluminal invasion and 7 suffered from bleeding into the trachea or airway obstruction. In contrast, none of the 13 who underwent extensive surgery, i.e. thyroidectomy, laryngectomy, partial resection of the trachea and one resection of the pharynx, (12 of whom had intraluminal invasion) showed either bleeding into the trachea or airway obstruction. Although the prognosis was no better in the group undergoing extensive operation there is the feeling that in cases with intraluminal invasion extensive surgery is indicated to prevent the severe airway difficulties which often develop in such patients.     

头颈部髓外浆细胞瘤临床分析

目的:总结头颈部髓外浆细胞瘤(EMP)的临床特征、诊断和治疗经验,提高治疗效果。方法:回顾性分析8例头颈部髓外浆细胞瘤的临床资料。发生于鼻腔3例、上颌窦2例、鼻咽部2例、口咽后壁1例。结果:8例均病理学确诊为浆细胞瘤,全部接受手术治疗,其中4例术后追行放疗。4例无瘤生存者分别已超过1年、5年、10年、12年;3例死亡,其中1例在出院2年后死于局部复发,1例3年后死于多发性骨髓瘤,1例2年后死于心脏病;失访1例。结论:头颈部髓外浆细胞瘤属于低度恶性肿瘤,诊断主要依靠临床表现和病理,手术和放疗是其主要治疗手段。     

Adenosquamous carcinoma of the upper aerodigestive tract: a clinicopathologic study of 12 cases and review of the literature

PURPOSE: Adenosquamous carcinoma is an uncommon, controversial neoplasm. To further comprehend its natural history, the clinical and pathological features of 12 new cases were reviewed and analyzed collectively with those described in the English literature. MATERIALS AND METHODS: Twelve cases of adenosquamous carcinoma of the upper aerodigestive tract with adequate follow-up and available microscopic slides and paraffin tissue blocks were identified in the anatomic pathology files of Presbyterian Hospital of the University of Pittsburgh Medical Center over the period 1983-2001. RESULTS: The 8 men and 4 women ranged in age from 34 to 81 years (mean, 62.8 years). The larynx (5 cases) and the floor of the mouth (4 cases) were the most common sites of origin. Nine patients had cervical lymph nodes positive for carcinoma (8 at diagnosis), 7 experienced local recurrences, and 2 developed distant metastases. Four of 10 (40%) patients with follow-up died of disease. Combining our cases with those in the literature (total of 58 cases) revealed similar findings: 64.7% were associated with positive cervical lymph nodes, 46.7% experienced local recurrences, 23.1% developed distant metastases, and 42.9% died of their disease at a mean follow-up period of 24.7 months. CONCLUSIONS: Adenosquamous carcinoma is an aggressive neoplasm with a tendency for early lymph node metastasis, frequent local recurrence, occasional distant metastasis, and death from disease, usually within 2-3 years. Surgery with neck dissection is the treatment of choice.