侧开式喉镜下喉动力系统切除会厌囊肿46例

会厌囊肿是由于会厌黏膜的黏液腺管阻塞、黏液潴留而形成［1］,常发生于会厌的舌面,囊肿较小时患者多无明显不适,多因其他疾病检查时发现,但有时并发感染发生急性会厌炎;囊肿巨大时可压迫会厌遮盖喉入口,易导致喉梗阻而危及生命,若并发感染则更加危险。直接喉镜下咬除囊肿［3］手术难度较大,完全切除囊壁较难,复发率高,且术中出血多,对正常会厌黏膜损伤较大,故术后患者咽喉疼痛明显,再出血可能性大;囊肿复发概率高,有时需数年后再次手术,患者痛苦增加。2011年1月至2014年5月,我们应用喉动力系统（美敦力公司,美国）对直径超过1．0 cm 的会厌囊肿患者46例,行手术切除,效果满意,报告如下。     

电视支撑喉镜下低温等离子治疗会厌囊肿

目的探讨支撑喉镜视频监视下低温等离子会厌囊肿切除的优点、疗效及手术体会。方法对采用支撑喉镜视频监视下低温等离子刀进行手术治疗的26例会厌囊肿的术中出血情况、手术时间、术后疼痛程度、住院天数、会厌创面伪膜脱落的时间、术后并发症及效果进行分析。结果患者术中出血情况（3.9±0.8）ml、手术时间（11.8±2.3）min、术后疼痛程度（视觉模拟评分法VAS）2.5±1.0、住院天数（2.4±0.7）d、会厌创面伪膜脱落的时间（11.8±2.6）d。术后患者均无呼吸不畅及会厌创面出血的并发症发生。全部病例随访3个月以上,无一例复发。结论采用电视支撑喉镜下低温等离子行会厌囊肿切除,具有术野清晰,术中出血少,手术时间短,对会厌组织创伤小,术后患者咽痛轻,会厌创面伪膜脱落时间短,无不良反应及并发症,愈后不易复发等优点,值得临床推广使用。     

支撑喉镜下电凝切除会厌囊肿12例

目的探讨利用电凝钩在支撑喉镜下切除会厌囊肿的可行性及治疗效果。方法使用电凝钩在支撑喉镜下对12例会厌囊肿患者进行了手术治疗,术后随访6～12个月。结果手术均一次性完成,无手术并发症。术后随访6～12个月均无复发。结论采用电凝钩在支撑喉镜下切除会厌囊肿具有疗效佳,损伤小,无并发症等优点。     

电子喉镜下氩气刀切除会厌囊肿

目的　探讨电子喉镜下氩气刀切除会厌囊肿的临床疗效。方法 回顾性分析2014年1月~2018年9月80例会厌囊肿患者经电子喉镜下氩气刀切除的临床资料,所有患者均在表面麻醉下完成手术。结果 80例会厌囊肿患者一次性完整切除病变,术中出血量少,手术时间5~30分钟,术后无发热、出血、呼吸困难、感染等并发症。随访3~36个月,无复发病例。结论 电子喉镜下氩气刀切除会厌囊肿,电子喉镜可放大手术视野,手术视野清晰,可多角度观察无死角,氩气刀对组织损伤小,出血少基本达到无血操作,手术时间短,术后反应轻,恢复快,手术效果确切,无须全身麻醉,就医成本低,值得临床推广。     

可视喉镜等离子系统切除会厌舌根良性病变71例

目的 探讨可视喉镜等离子系统切除会厌舌根病变的适应证和手术方法,总结运用这种方法进行手术切除会厌舌根病变的经验。 方法 对经常规检查临床初诊为会厌舌根乳头状瘤、舌扁桃体增生、会厌囊肿等良性病变的患者,在可视喉镜等离子手术系统下进行病变切除,术后随访病变复发与并发症情况。 结果 经过临床初诊符合条件的舌根会厌良性病变患者71例,其中会厌囊肿44例,会厌舌根乳头状瘤17例,舌扁桃体增生10例。均经气管插管全麻,在可视喉镜和等离子手术系统辅助下完成病变切除。术后均恢复良好,除2例迟发型术后出血外,无其他并发症。其中舌扁桃体增生和舌根会厌乳头状瘤均经病理最后确诊。随访6~18个月,病变均无复发。 结论 舌根会厌良性病变可以在可视喉镜等离子系统下方便快捷的经口切除,该术式具有暴露充分、视野宽广、切除彻底、创伤小、安全性良好、并发症少和疗效确切的优点。     

支撑喉镜下超声刀切除会厌囊肿

目的探讨支撑喉镜下超声刀切除会厌囊肿的临床应用。方法对我科2008年2月～2009年8月收治的86例会厌囊肿患者,按照随机数字表法随机分为治疗组43例,对照组43例,两组均在支撑喉镜下进行。治疗组采用超声刀治疗,对照组采用高频电刀手术切除并比较其临床疗效。结果治疗组出血明显减少、手术时间明显缩短、术后疼痛减轻,两组术后均无复发。对照组有2例术后会厌部分缺损。结论支撑喉镜下超声刀手术治疗会厌囊肿有手术时间短,术中极少出血,术后疼痛轻,并发症少,复发率低等优点。     

电离子治疗复发性巨大会厌囊肿

会厌囊肿是喉科常见病,如手术不当易反复发作且处理辣手。笔者于1997年1月运用GX——Ⅲ多功能电离子手术治疗机（广西科学院应用物理研究所研制）治疗复发性巨大会厌囊肿卫例,报告如下。1临床资料患者,男,48岁,农民。因反复喉部异物感5年,吞咽不适来诊。患者曾在当地市医院以“会厌囊肿”作过2次手术。第一次在表麻下切除囊壁,喉部症状一度消除,不久又见囊肿复发。2年前在全麻下作第H次手术。较彻底切除囊肿,但3月后检查又见复发,而来我院要求中西医结合治疗。间接喉镜检查囊肿位于会厌舌面右侧,已达会厌谷及其皱美,约2．scmX…     

继发于会厌囊肿感染的急性会厌炎的治疗分析

目的　探讨继发于会厌囊肿感染的急性会厌炎的综合治疗的效果。方法　2016年6月~2020年6月在南京同仁医院耳鼻咽喉头颈外科住院治疗的继发于会厌囊肿感染的急性会厌炎的患者62例，其中经保守治疗3~7 d后会厌脓肿局限，感染控制平稳后再行支撑喉镜下显微镜下CO2激光会厌囊肿切除术的32例患者为实验组，术中完整切除会厌囊肿，同期单纯行保守治疗的30例患者为对照组，比较两组治疗效果的差异。结果　实验组患者术后患者创面愈合良好，无术后出血及感染、急性会厌炎复发等并发症。实验组有效率为100%、治愈率为100%，对照组有效率为70%、治愈率为40%，实验组有效率和治愈率均高于对照组（χ2=11.23、27.055，P<0.05）。实验组复发率为0，低于对照组复发率20%，差异有统计学意义（χ2=7.086，P<0.05）。结论  会厌囊肿感染继发急性会厌炎的综合治疗，先保守治疗控制感染局限，再手术治疗彻底切除病变组织，这种综合治疗方案有很好的效果。     

可视喉镜在婴幼儿会厌囊肿摘除术中的应用

目的探讨可视喉镜在婴幼儿会厌囊肿手术中的应用前景。方法对2010年1月至2014年2月收治的76例婴幼儿会厌囊肿患儿的临床资料进行回顾性分析。全组患儿均在完善术前检查后在全麻气管插管可视喉镜下行会厌囊肿切除术,术后定期随访。结果 76例患儿均顺利接受手术,术中、术后无并发症出现,术后有2例患儿送重症监护病房监护24~48h。所有患儿手术后住院时间少于8d,出院时喉鸣、气促、进食时呕吐症状均明显改善或消失,所有患儿术后随访6个月以上未见复发。结论可视喉镜下切除婴幼儿会厌囊肿具有手术时间短、出血少、损伤小、术后组织反应轻等优点。     

麻醉喉镜下低温等离子射频消融显微手术治疗巨大会厌囊肿

目的探讨麻醉喉镜下显微镜下低温等离子射频消融术治疗巨大会厌囊肿的疗效。方法 2013年1月~2016年1月年我科收治的30例巨大会厌囊肿患者,男18例,女12例,年龄26~57岁,均在全麻麻醉喉镜下显微镜下暴露会厌,用低温等离子喉刀头行会厌囊肿射频消融术,观察术后创面恢复情况及有无复发。结果术后创面干净,术后1月假膜完全脱落,无大出血及假膜脱落引起内源性气管异物等并发症,术后随访1年,无1例复发。结论全麻下麻醉喉镜配合显微镜低温等离子射频消融治疗巨大会厌囊肿临床疗效满意,安全可靠,有独特的优势。     

胸外科长柄电刀在会厌囊肿切除术中的应用

目的 探讨应用胸外科长柄电刀切除会厌囊肿的疗效.方法 将66例会厌囊肿患者随机分成胸外科长柄电刀切除组(实验组)及常规摘除组(对照组),每组33例.两组均在气管插管静脉复合全麻下行支撑喉镜下手术,比较二组术中出血量、手术时间、术后疼痛程度、术后疗效.结果 实验组与对照组比较,前者术中出血量明显减少,手术时间明显缩短,术后疗效明显好,差异具有统计学意义(P<0.05);两者术后疼痛程度比较,差异无统计学意义(P>0.05).结论 采用胸外科长柄电刀在支撑喉镜下切除会厌囊肿具有术中视野清晰、出血量少、手术时间快短、术后疗效好等优点.     

Lymphatic malformation of the epiglottis—A case report and review of the literature

A 2-year-old male with a new onset dysphagia was diagnosed with a huge multicystic lesion of the epiglottis. The patient was urgently operated and several cysts were resected using cold steel instruments under microscopic view. Histopathology was consistent with lymphatic malformation. Surgery resulted in total symptoms resolution and on 1 year follow-up the patient remained free of recurrence.This is the first report of epiglottic lymphatic malformation.     

喉源性阻塞性睡眠呼吸暂停低通气综合征的临床观察

目的 探讨喉源性阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的病因、临床表现和治疗特点。方法 回顾分析13例经治疗喉原发病使OSAHS获得有效治疗而确诊为喉源性OSAHS的病例,总结分析其病因、临床表现和治疗特点。结果 造成喉源性OSAHS发病原因包括双侧声带麻痹、喉乳头状瘤、会厌肿瘤、会厌软化等,主要由声门和会厌病变引起喉内呼吸道狭窄所致;此类患者多不肥胖,声门病变导致OSAHS者多数存在轻度呼吸困难,经治疗喉原发病,OSAHS获得了很好疗效。结论 喉腔疾病可以导致喉源性OSAHS的发生,临床上喉源性OSAHS并非罕见,治疗喉原发病可以使喉源性OSAHS得到有效治疗。     

低温等离子消融术与传统术式治疗会厌囊肿的疗效比较观察

目的比较低温等离子消融术与传统手术方法治疗会厌囊肿的临床疗效。方法2012年7月-2014年1月收治的42例会厌囊肿患者,随机分为治疗组和对照组,均在全麻支撑喉镜引导下手术。治疗组采用低温等离子射频消融术,对照组采用喉钳切除术。观察比较两种手术方法的优越性及其临床疗效。结果与传统方法比较,低温等离子手术的手术时间明显缩短、术中出血量明显减少、术后疼痛时间甚短、黏膜修复很快,差异具有统计学意义（P〈0．05）。术后随访1年,对照组病变复发19例,而治疗组无1例出现病变复发。结论低温等离子治疗会厌囊肿临床疗效满意,安全可靠,值得推广。     

电子喉镜下巨大声带息肉摘除术

目的：探讨电子喉镜下巨大声带息肉摘除术的可行性及疗效。方法：选择巨大声带息肉患者10例,3例伴有I度呼吸困难,在表面麻醉电子喉镜下行声带息肉摘除术。结果：8例一次性完成手术, 2例分两次完成手术,所有患者无手术并发症,术后3个月的嗓音评价及嗓音测试表明,患者嗓音完全恢复正常。结论：电子喉镜下声带巨大息肉摘除可行,但需充分掌握手术技巧,联合应用表麻药,在做好气管切开的准备情况下进行手术。     

Lateral saccular cysts of the larynx. Aetiology, diagnosis and management

Lateral saccular cysts have been diagnosed in 17 patients. Definitive diagnosis was made by computed tomography (CT) that showed a fluid-filled cystic swelling of the saccule with no air fluid level in all patients. Fifty-three per cent of cysts were bulging through the thyrohyoid membrane. They were hugely enlarged in 18 per cent, moderately enlarged in 24 per cent, and slightly enlarged in 12 per cent of patients. One patient (six per cent) showed bilateral cysts. Lateral saccular cysts were primary in origin in 82 per cent of patients and secondary to prolonged intubation, hemilaryngectomy, and laryngoscleroma in 18 per cent of patients. Surgical excision via a lateral cervical approach was performed in eight patients, whereas endoscopic CO2 laser vestibulectomy was performed in nine patients. Endoscopic vestibulectomy with CO2 laser proved to be an efficient and safe procedure for excision of small and medium-sized cysts with a diameter equal to or less than 3 cm in the greatest dimension. The external approach appears more efficient than laser vestibulectomy in excision of huge cysts, as 22 per cent of patients undergoing laser surgery showed a recurrence.     

Laryngeal cysts: clinical relevance of a modified working classification

Laryngeal cysts from 72 patients were examined and reclassified according to a modified working classification. In this series, 47 patients (66 per cent) had epithelial cysts, 11 patients (15 per cent) oncocytic cysts and 14 patients (19 per cent) tonsillar cysts. Epithelial cysts were commonest in the region of the epiglottis (20/47) and laryngeal ventricle (24/47). Oncocytic cysts tended to lie in the region of the ventricle whereas tonsillar cysts occurred almost exclusively in the valleculae, epiglottis and pyriform region (13/14). The authors conclude that the modified working classification of laryngeal cysts is easy to apply, of clinical relevance, and allows classification of cysts where operative trauma to the specimen obscures the relationship of the cyst to the surface epithelium. The origin and significance of tonsillar cysts are discussed and a relationship to the lympho-epithelial cyst of the oral cavity is suggested.     

Surgical approach to submucosal lesions of the supraglottic larynx: the supero-lateral thyrotomy.

The surgical approach to the hypopharynx by lateral pharyngotomy as described by Trotter has found widespread use in management of supraglottic carcinoma. A similar but more conservative approach may be employed for removal of cysts and benign or well-encapsulated neoplasms of the epiglottis and supraglottic space. We call this approach a supero-lateral thyrotomy, to differentiate it from the classic lateral pharyngotomy. Surgery consists of subperichondrial resection of the superior half of the ipsilateral thyroid cartilage with preservation of internal lining and superior laryngeal nerve. The lesion may then be enucleated or resected, and the defect, if any exists, closed with overlying mucosa and the flap of preserved perichondrium. The technique has been employed in cases of paraganglioma, haemangiopericytoma and saccular cysts.     

Pearls and pitfalls in the management of branchial cyst

INTRODUCTION: Although branchial cysts may present as asymptomatic swellings, about one-third present acutely due to inflammation. The use of fine-needle aspiration biopsy (FNAB) and computerized tomography (CT) is controversial. The treatment of inflamed cysts is also controversial. AIMS: To compare the findings of FNAB and CT between cases of branchial cysts presenting as an asymptomatic swelling, and those presenting acutely due to inflammation, and to examine the management of infected cysts. MATERIALS AND METHODS: Retrospective review of the medical records of 39 adult patients with histologically proven branchial cysts treated by the senior author (C.V.T.) between 1994 and 2003. RESULTS: Twenty-eight patients presented with an asymptomatic swelling. Eleven presented acutely with inflammation. A higher incidence of indeterminate fine needle aspirates and atypical CT features were found in the inflamed group. Initial treatment in the infected group consisted of intravenous antibiotics, followed by aspiration or surgical exploration in non-resolving cases. Interval excision after six weeks was performed in all inflamed cases without complication. CONCLUSIONS: FNAB is recommended in all cystic neck lumps to rule out malignancy, but may be inconclusive, especially in inflamed cysts. Inflamed cysts are best treated with intravenous antibiotics, with or without aspiration or incision and drainage, followed by interval excision.