支撑喉镜下CO2激光喉肿瘤手术的并发症分析

目的 分析支撑喉镜下CO2激光喉肿瘤手术的并发症.方法对520例喉肿瘤患者支撑喉镜下行CO2激光手术,术后进行并发症分析.结果CO2激光引起的并发症61例,占11.73%;支撑喉镜造成的并发症71例,占13.65%.结论CO2激光喉手术须经支撑喉镜进行,故并发症可分为激光损伤造成的并发症和支撑喉镜造成的并发症.     

两种手术方法治疗双侧声带神经麻痹

目的 通过观察经喉外进路及经支撑喉镜下行CO2激光手术切除杓状软骨治疗双侧声带神经麻痹的疗效,对比两种手术方法的优缺点,择优选取合适的术式。方法 对双侧喉返神经致喉狭窄的13例术后患者进行随访,其中7例行喉外进路杓状软骨切除术声带外展固定,6例行经支撑喉镜下行CO2激光手术切除杓状软骨,13例术前均已行气管切开,术后随访6个月至2年。结果 采用喉外进路杓状软骨切除术声带外展固定7例,术后1次拔管3例,2次拔管2例;采用经支撑喉镜下行CO2激光手术切除杓状软骨6例,术后1次拔管4例,2次拔管1例。结论 两种手术方法各有优缺点。     

声带息肉合并喉梗阻症状的治疗方法探讨

目的　研究喉显微镜支撑喉镜下CO2激光手术治疗声带息肉合并不同程度喉梗阻患者的疗效。方法　选取18例声带息肉伴有不同程度喉梗阻患者为研究对象,均采用纤维支气管镜引导下经鼻气管插管,实施喉显微镜支撑喉镜下CO2激光切除声带息肉手术,术后1个月复查电子喉镜,统计患者治疗总有效率及嗓音功能恢复、并发症以及术后复发等情况。结果　18例患者均一次性插管成功,无气管切开病例,除2例口咽侧壁擦伤外无其他并发症,术后呼吸困难症状改善明显,术后1个月嗓音功能恢复良好, 治愈14例（77.78%）,好转4例（22.22%）,随访半年,无复发病例。结论　纤维支气管镜引导下经鼻气管插管,CO2激光显微外科手术是治疗声带息肉合并喉梗阻患者安全、有效、微创的手术方法,值得临床推广应用。     

CO2激光治疗室带肥厚导致的发音障碍

目的　探讨显微支撑喉镜下CO2激光治疗室带肥厚导致的发音障碍的临床疗效。方法　2011年12月～2013年12月因室带肥厚导致发音障碍就诊于我科的40例经保守 治疗无效的患者,所有患者均经动态喉镜和嗓音分析检查（包括基频、基频微扰、振幅微扰和谐燥比）,并在全身麻醉下行显微支撑喉镜CO2激光手术切除肥厚的室带,术后再次查动态喉镜和嗓音分析,并与术前进行对比。结果  40例患者术后声嘶明显改善,室带恢复正常水平,基频微扰、振幅微扰均降低,基频和谐燥比升高 ,声带黏膜波恢复正常,无并发症发生。结论　显微支撑喉镜CO2激光治疗室带肥厚导致的发音障碍是安全、可靠的,实用性强。     

支撑喉镜下CO2激光显微切割治疗乳头状喉角化症

目的探讨支撑喉镜下CO2激光显微切割治疗乳头状喉角化症的疗效。方法回顾性分析2004年1月～2011年11月在中南大学湘雅医院耳鼻咽喉头颈外科收治的10例乳头状喉角化症患者支撑喉镜下行CO2激光显微切割治疗的临床资料。结果随访1～5年,8例患者病变在治疗后消失;1例复发,再次进行支撑喉镜下CO2激光显微切割治疗后病变消失,1例因癌变行垂直半喉切除术。结论支撑喉镜下CO2激光显微切割治疗乳头状喉角化症具有疗效确切、创伤小、术后恢复快等优点。     

CO2激光单侧杓状软骨次全切除术治疗双侧外展性声带麻痹

目的　探讨CO2 激光单侧杓状软骨次全切除术治疗双侧外展性声带麻痹手术的适应证及临床意义。方法　支撑喉镜下对 8例双侧外展性声带麻痹伴呼吸困难的患者实施了CO2 激光单侧杓状软骨次全切除术和手术创面黏膜吻合术。其中 ,继发于双侧甲状腺切除术 5例 ,外伤所致双侧外展性声带麻痹 2例 ,原因不明 1例。术前接受气管造口术 5例 ,气管切开术 1例。术后通过纤维喉镜检查患者新建声门裂的通气情况 ,发音质量主观评估由患者本人和医疗小组共同完成。结果8例患者术后均恢复了满意的呼吸功能 ,发音质量均无明显下降 ,平均气管套管拔除时间为 44 2d。术后随访 5～ 43个月 ,没有出现误吸和再狭窄等并发症。结论　支撑喉镜下CO2 激光单侧杓状软骨次全切除术和创面黏膜吻合术简单易行 ,创面小 ,术后愈合快 ,可避免肉芽组织增生和瘢痕形成所导致的声门区再狭窄 ,患者的呼吸和发音功能均得到了满意的恢复和保留     

CO2激光治疗喉癌前病变及早期声门型喉癌的疗效分析

目的 探讨CO2激光治疗喉癌前病变及早期声门型喉癌的临床效果.方法 选取2014年1月～2019年9月在我科行支撑喉镜下CO2激光显微手术治疗喉癌前病变及早期声门型喉癌患者30例(喉癌前病变20例,早期声门型喉癌10例),观察患者术后恢复情况.结果 30例患者均完成手术,术中均未出现并发症.3例患者因病灶累及前联合,术...     

支撑喉镜下CO2激光手术治疗喉乳头状瘤

目的　观察支撑喉镜下CO2激光治疗喉乳头状瘤患者,分析其治愈率、复发率、复发时间及相关并发症,分析该技术的优缺点。方法　回顾性分析2012年2月～2014年6月经CO2激光治疗的喉乳头状瘤39例,均采用经口显微镜支撑喉镜下CO2激光治疗,全麻后支撑喉镜暴露喉乳头状瘤并固定,显微镜下CO2激光切除喉乳头状瘤。结果 随访1个月～2年,总体有效率约53.85%,复发率约42.56%,平均手术次数3.14次,平均复发时间约为7.6个月。结论 CO2激光出血少、手术时间短、术后恢复快且并发症较少见,值得临床推广。     

CO2激光结合改良T型管植入术治疗喉狭窄

目的　研究CO2 激光技术结合放置T型硅胶管治疗成人及儿童喉狭窄的治疗效果。方法　全身麻醉支撑喉镜下CO2 激光切除喉内瘢痕 ,扩大气管造口向上引置T型硅胶管 ,治疗成人及儿童喉狭窄患者 2 2例 ,随访 1～ 3年。结果　 2 2例患者在 1 2～ 2 4个月后经检查拔除T型管 ,其中 2例T型管位置放置过高和 2例T型管的位置过低 ,再次手术重新放置T型管。结论　应用CO2 激光技术结合放置T型硅胶管治疗成人及儿童喉狭窄具有治疗效果好、创伤小、操作简便和术后恢复快等优点。     

支撑喉内镜下环杓关节复位——附8例报告

目的 探讨经支撑喉内镜下治疗环杓关节半脱位的手术疗效、复位技巧,并讨论与其相关的病因和诊断.方法 8例因气管内插管致环杓关节半脱位患者,在支撑喉镜下鼻内镜辅助环杓关节复位术,随访0.5～2年,平均15个月.结果 7例1次手术复位成功,声音恢复正常;1例手术失败,声带活动改善不明显.术中术后均未发生其他并发症.结论 支撑喉镜内镜下环杓关节复位手术方法简单、安全、成功率高.     

Laser resection of localized subglottic amyloidosis

A case of localized amyloidosis of the subglottis is described. Urgent endotracheal intubation and later tracheostomy were required for upper airway obstruction. The amyloid was completely resected endoscopically using the CO2 laser. There is no evidence of recurrence two-and-a-half years after surgery.     

CO2激光在喉部手术后并发声带粘连的相关因素分析及预防

目的　探讨CO2激光喉显微手术后发生声带粘连的影响因素。方法　选择2012年10月～2016年12月我科采用CO2激光治疗219例喉部病变患者作为研究对象,就性别、年龄、病变性质、病变部位、激光功率和术后肉芽增生等相关因素,分析其与声带粘连的关系,并进行统计学分析。结果　219例患者中发生声带粘连31例,发生率为14.16%。术后声带粘连与病变性质、病变部位、激光功率、术后是否有肉芽增生等因素有关。结论　喉部病变CO2激光应根据不同的病变性质及病变部位,采取适当的手术方式和切割功率,术中、术后采取必要的综合措施,有助于减少术后声带粘连的发生。     

Anesthesia for CO2 laser surgery of the larynx

The CO2 laser is a useful surgical tool in laryngology, but adds a significant anesthetic risk because of a constant fear of fire. This paper reviews the anesthetic problems of laryngology in general - competition for the airway between surgeon and anesthetist, circulatory changes associated with laryngoscopy, and postoperative laryngospasm and edema, as well as operating room pollution together with problems unique to laser usage. If endotracheal tubes are used, they may burn, the laser may be misaligned, endotracheal cuffs may burst, and there is a constant risk of a flash fire. The techniques favored are either a small born endotracheal tube wrapped in aluminum foil or an injection technique. The former may obstruct laryngeal lesions. The injection technique is described in detail together with the pharmacological management of anesthesia.     

喉非特异性肉芽肿治疗方法的优先选择

目的 探讨喉非特异性肉芽肿的综合治疗方式的优先选择及治疗效果。方法 确诊为喉非特异性肉芽肿的患者20例,对8例有气管插管史者,未经任何保守治疗即行支撑喉镜下手术治疗,术后吸入类固醇2周;12例无气管插管史者,给予制酸药为主,支撑喉镜下手术、吸入类固醇、语音疗法为辅的治疗。结果 所有患者治疗疗程结束后随访6个月,有气管插管史患者出现复发1例,经再次手术、术后吸入类固醇治疗后治愈;无气管插管史患者,10例仅经制酸治疗后症状完全消失,2例经同时配合予支撑喉镜下手术、吸入类固醇及语音疗法后治愈。结论 喉非特异性肉芽肿病因复杂,治疗方法多样,对于有气管插管史者,优先选择手术及术后吸入类固醇治疗可缩短治疗时间,疗效显著;对于无气管插管史者,优先选择以制酸治疗为主的综合治疗,疗效显著。     

Airway protection and the laryngeal mask airway in sinus and nasal surgery

OBJECTIVES/HYPOTHESIS: The objective was to compare the laryngeal mask airway and endotracheal tube for airway protection from blood during sinonasal surgery. STUDY DESIGN: Nonrandomized, controlled, prospective clinical trial. METHODS: Patients scheduled to undergo sinonasal surgery (septoplasty and/or endoscopic sinus surgery) were prospectively enrolled and grouped according to type of airway during general anesthesia with choice of airway device based on the anesthesiologist's preference. Clinical data were tabulated by case including airway device, patient age, weight, estimated blood loss, airway pop-off pressure, and emergence quality. At the conclusion of surgery, the airway was examined through the laryngeal mask airway or endotracheal tube with a flexible fiberoptic bronchoscope to determine the amount of blood present on the vocal cords or in the trachea. The airway device was also evaluated postoperatively for the presence of blood. RESULTS: Seventy-six adult patients were initially enrolled; two were excluded because fiberoptic evaluation of the airway could not be completed. Of the remaining 74 patients, an endotracheal tube and laryngeal mask airway were used in 31 and 43 patients, respectively. The two groups did not differ with respect to age, weight, estimated blood loss during surgery, pop-off pressure, or emergence quality (all P >.05). Patients managed with an laryngeal mask airway were significantly less likely to have blood staining the airway (glottis or trachea) than patients with an endotracheal tube (19.5% vs. 84.8%, chi test [P <.001]). However, the endotracheal tube provided better protection than the laryngeal mask airway against distal tracheal blood contamination (3.2% vs. 14.6%, respectively [P =.110]). CONCLUSION: The laryngeal mask airway provides better protection of the upper airway from blood contamination during sinonasal surgery than a standard endotracheal tube, but there is a higher incidence of distal tracheal contamination. The laryngeal mask airway is a reasonable alternative to endotracheal intubation for airway management in sinonasal surgery.     

支撑喉镜下CO2激光分离联合硅胶膜置入治疗继发性声带粘连

目的 探讨支撑喉镜下应用CO2激光分离切除声带蹼样粘连后置入硅胶膜治疗继发性声带粘连的临床疗效.方法 以21例继发性声带粘连的成年患者为研究对象,其中,发生于双侧声带任克水肿、声带小结、声带息肉、声带白斑手术后16例,喉乳头状瘤手术后4例,喉部外伤导致声带粘连1例,粘连范围均为声带前1/3～1/2;均在支撑喉镜下应用CO2激光分离并切除声带前部正中粘连带后,置入的硅胶膜使其隔离声门前端分离的创面并经喉内、外联合进路缝合固定于颈前皮肤;术后3周取出硅胶膜,随访半年,观察疗效.结果 20例患者术后3周顺利取出硅胶膜,1例患者术后2周因颈部软组织感染取出硅胶膜后痊愈;术后随访6个月,除1例患者再次发生声带前联合粘连外,其余20例患者声带前联合均获得良好三角形形态,无瘢痕及肉芽形成,声嘶均明显改善.结论 支撑喉镜下CO2激光分离联合硅胶膜置人隔离创面3周治疗声带粘连,创伤小,效果好,并发症少.     

Flexible Nd:YAG laser palliation of obstructive tracheal metastatic malignancies.

Flexible Nd:YAG endoscopic laser surgery may become an effective new modality for palliation in patients with obstructive endotracheal metastatic malignancies. We report the results of the treatment of two patients with severely obstructing intraluminal tracheal metastatic melanoma and medullary thyroid carcinoma, using the neodymium-YAG laser via the flexible fiberoptic bronchoscope. Both patients complained of significant dyspnea, orthopnea, cough, and hemoptysis and were not candidates for rigid bronchoscopy because of underlying medical contraindications and anatomical problems. Multiple treatment sessions were used with treatment intervals of 1 to 2 weeks. All treatments were performed in the operating room under sedation, without intubation, with topical lidocaine and standard superior laryngeal nerve block. Successful relief of airway obstruction with complete regression of the endotracheal masses was achieved and no recurrences were seen after 9 months' follow-up. Flexible Nd:YAG laser bronchoscopy offered an alternative for the relief of obstructing endotracheal or bronchial malignancies in patients in whom the rigid bronchoscope could not be passed. it seemed to prolong survival in selected cases, and provided definite improvement in quality of life.     

Laryngeal mask anesthesia with intraoperative laryngoscopy for identification of the recurrent laryngeal nerve during thyroidectomy

OBJECTIVES/HYPOTHESIS: A critical step in thyroidectomy involves definitive identification of the recurrent laryngeal nerve (RLN). Using the laryngeal mask airway, identification of the RLN can be facilitated by stimulation of the nerve while monitoring vocal cord movement with a fiberoptic laryngoscope. We present this technique as an effective and safe means to identify the RLN during thyroid surgery, with significant advantages over existing techniques in appropriately selected patients. STUDY DESIGN: Retrospective case series. METHODS: We performed thyroidectomy on 8 patients (13 RLN identifications) in which laryngeal mask airway anesthesia with fiberoptic laryngoscopy was used to identify the RLN. Results are reviewed with regard to postoperative vocal cord function, as well as intraoperative and postoperative courses with laryngeal mask airway anesthesia. RESULTS: In all 13 cases in which the RLN was sought, it was definitively identified by witnessing brisk vocal cord movement on a video screen with stimulation of the RLN. No patient had postoperative vocal cord paresis or paralysis. Overall recovery from laryngeal mask airway anesthesia was uneventful and had advantages when compared with general anesthesia with endotracheal intubation. CONCLUSIONS: Laryngeal mask airway anesthesia with intraoperative fiberoptic laryngoscopy to identify the RLN is effective and safe in carefully selected patients. Advantages include decreased postoperative throat discomfort, absence of coughing during emergence from anesthesia, and elimination of the possibility of vocal cord mobility impairment secondary to RLN ischemia from the endotracheal tube balloon. In addition, this technique is applicable in operations besides thyroid surgery, in which definitive identification of the RLN is indicated.     

Retrograde nasal intubation via the cleft in Pierre-Robin Sequence neonates: A case series

Pierre-Robin Sequence, the triad of glossoptosis, micrognathia and cleft palate, provides a challenge in airway management both in and out of the operating room. Transnasal intubation is greatly preferred during its surgical intervention for maximum oral exposure in these very small patients without the added encumbrance of an oral endotracheal tube. From 2001 to 2009, three neonates with Pierre-Robin Sequence who underwent surgery to improve their airway had a novel method of securing a transnasal airway performed in the operating theater. After successful placement of a laryngeal mask airway (LMA) and subsequent endotracheal intubation via the LMA, this technique was used to convert from an oral to a nasal intubation. After the LMA is removed, a smaller endotracheal tube is placed into the nose and out of the mouth via the cleft in each of these patients. This smaller tube is then telescoped into the larger one and secured with suture. Both tubes are subsequently backed out of the nose in a retrograde fashion and disarticulated so that the now transnasal endotracheal tube can be re-connected to the anesthesia circuit. This case series highlights a rapid technique utilizing the patient's congenital defect for securing a transnasal airway alternative to that of transnasal fiberoptic intubation in Pierre-Robin Sequence neonates.     

Acute laryngeal injury with short-term endotracheal anesthesia

Endotracheal intubation provides an excellent way of controlling a patient's airway. Except in long term intubation, where pressure necrosis, secondary infection and cicatrix formation are known causes of complications, an endotracheal tube is usually not considered a significant laryngeal hazard. The following case reports of arytenoid dislocation, laryngeal laceration, pseudomembrane formation and vocal cord paralysis, illustrate the etiology and clinical problems that result from unsuspected laryngeal injury following elective short-term endotracheal intubation for anesthetic purposes. Because most post-extubation symptoms are thought to be caused by edema, the larynx is rarely examined, and the patient's symptoms are either ignored or treated with some combination of cold steam, steroids and antibiotics. Diagnosis and management of these injuries, is frequently compromised or delayed until either the symptoms persist for five to seven days or until airway obstruction, severe pain or aphonia develop.