支撑喉内镜下咽喉部微创手术的临床应用

目的：探讨支撑喉内镜系统手术治疗咽喉部疾病的临床应用价值，进一步改进咽喉部微创手术方式。方法：全麻下采用支撑喉内镜系统微创手术治疗34例咽喉疾病患者，术中微波等处理残灶及出血区；恶性肿瘤术后行40Gy放疗。结果：本组34例患者均一次手术成功，随访1～16个月．未见严重手术并发症；术前已发生声嘶的26例良性病变者术后1个月内发声恢复正常；2例早期声带癌术中保留喉结构和功能，随诊6～12个月未见肿瘤复发，声嘶明显好转。结论：支撑喉内镜微创手术治疗咽喉部良性病变、早期声带癌及癌前期病变具有重要价值，该项技术具有视野大、清晰度高、照明度好、切除病变彻底、保留结构功能好等优点．值得临床推广应用。     

激光治疗喉癌前病变

目的在手术治疗喉癌前病变的同时,最大限度的保留和恢复喉的正常发音功能。方法应用激光外科手术治疗喉癌前病变77例,其中采用声带黏膜上皮层切除术治疗声带黏膜白斑及轻度不典型增生23例;采用声带黏膜剥脱术治疗中、重度不典型增生44例;激光切除成人型喉乳头状瘤10例。结果23例声带黏膜白斑及轻度不典型增生者术后2个月发音恢复正常;44例中、重度不典型增生者术后3～5个月发音逐渐恢复正常;10例喉乳头状瘤患者术后发音明显优于经颈进路手术的发音。结论嗓音显微外科手术既能分层切除声带病变,又能最大限度的保留和恢复喉的发声功能,是治疗喉癌前病变首选的微创性方法。     

嗓音显微外科技术的临床应用

目的 对于喉部病变，在得到有效治疗的同时，最大限度地保留正常和高质量的发声功能。方法 1986－2000年中日友好医院耳鼻咽喉科应用嗓音显微外科技术治疗1153例喉部疾病。根据喉部各种良性病变（声带小结、声带息肉、Reinke水肿、声带囊肿等）和不同阶段早期恶性病变及声带癌前病变侵犯的组织学深度，分别采用显微切除技术、外侧微瓣技术、内侧微瓣技术、黏膜下注射技术、黏膜剥脱及激光切除术等，切除病变组织，最小伤及正常组织和对发音质量的影响。结果 1044例（99．8％）声带小结、声带息肉、声带囊肿和12例Reinke水肿在通过显微切除技术、外侧微瓣技术、内侧微瓣技术等治疗后均能在1周后获得正常发音，2例巨大声带息肉患者半年内声嘶改善不满意；20例Reinke水肿、31例癌前病变经黏膜剥脱及黏膜表皮剥脱处理，除3例癌前病变术后复发又经2、3次手术，其余均在1－3个月内恢复正常发音。34例声带癌经黏膜剥脱处理，5例声带癌和5例喉乳头状瘤经激光切除，术后5年以上随访5例声带癌复发，其中2例再次行黏膜剥脱术，1例乳头状瘤反复4、5次手术。治疗后的发音效果均比经颈部切除手术好。结论 嗓音显微外科技术是彻底治疗喉部疾病同时可以最大限度保留声带发声功能的重要手术方法。     

喉部瘤囊肿

瘤囊肿由上皮细胞所组成,这种细胞呈嗜伊红胞浆和有一多色素的小核仁。它常见于唾液腺、呼吸道粘膜的腺体和其排泄管中,很少发生在喉部,以往文献报导仅77例。在喉部者以发生在喉室和假声带者居多,但也见于声带、前联合,声门下区、杓状软骨或声门上区。此囊肿外     

支撑喉内镜下手术218例分析

目的分析总结支撑喉内镜下手术治疗喉部疾病的方法。方法选取2002年8月～2008年8月接受支撑喉内镜手术治疗的218例患者,对手术方法及相关经验教训进行回顾性分析。结果所有患者在接受治疗后,声音恢复正常者143例,发音明显改善者29例。随访0.5～5年,复发需再次手术4例,其中1例为声带白斑,1例为中重度鳞状细胞不典型增生,2例为乳头状瘤。结论喉内镜手术治疗不同的喉部疾病,应有相应不同的手术方法和技巧。     

嗓音显微外科技术的临床应用

目的　对于喉部病变 ,在得到有效治疗的同时 ,最大限度地保留正常和高质量的发声功能。方法　 1986～ 2 0 0 0年中日友好医院耳鼻咽喉科应用嗓音显微外科技术治疗 115 3例喉部疾病。根据喉部各种良性病变 (声带小结、声带息肉、Reinke水肿、声带囊肿等 )和不同阶段早期恶性病变及声带癌前病变侵犯的组织学深度 ,分别采用显微切除技术、外侧微瓣技术、内侧微瓣技术、黏膜下注射技术、黏膜剥脱及激光切除术等 ,切除病变组织 ,最小伤及正常组织和对发音质量的影响。结果10 4 4例 (99 8% )声带小结、声带息肉、声带囊肿和 12例Reinke水肿在通过显微切除技术、外侧微瓣技术、内侧微瓣技术等治疗后均能在 1周后获得正常发音 ,2例巨大声带息肉患者半年内声嘶改善不满意 ;2 0例Reinke水肿、31例癌前病变经黏膜剥脱及黏膜表皮剥脱处理 ,除 3例癌前病变术后复发又经 2、3次手术 ,其余均在 1～ 3个月内恢复正常发音。 34例声带癌经黏膜剥脱处理 ,5例声带癌和 5例喉乳头状瘤经激光切除 ,术后 5年以上随访 5例声带癌复发 ,其中 2例再次行黏膜剥脱术 ,1例乳头状瘤反复 4、5次手术。治疗后的发音效果均比经颈部切除手术好。结论　嗓音显微外科技术是彻底治疗喉部疾病同时可以最大限度保留声带发声功能的重要手术方法     

支撑喉镜下YAG激光治疗喉部疾病(摘要)

支撑喉镜下ＹＡＧ激光治疗喉部疾病（摘要）李凤琴，邵洪武本文报告在支撑喉镜下应用ＹＡＧ激光对８０例喉部疾患进行治疗的临床观察，其中声带息肉５８例、喉角化症８例、喉乳头状瘤６例、喉癌（声门型Ｔ１Ｎ０Ｍ０）３例、喉癌术后喉狭窄５例，均取得较好的临床疗效。认...     

电动切削及射频治疗在喉显微手术中的应用

支撑喉镜下将喉内镜连接电视显像录像、打印、电动切削系统 ,结合射频治疗仪用于喉部微创手术 ,是近年来喉手术方式的一大进步。我院自2 0 0 0年底以来对 16 0例喉部病变进行手术 ,取得了满意效果。现报告如下。1　资料和方法1.1　一般资料16 0例中 ,男 12 0例 ,女 4 0例 ;年龄 5～ 5 4岁。声音嘶哑 2个月～ 5年。病变部位 :声带前 1/3段97例 ,前连合 34例 ,占全声带 2 9例 ;其中 82例为双侧声带病变。病理诊断 :声带息肉 96例 ,声带囊肿 9例 ,任克水肿 11例 ,喉乳头状瘤 17例 ,原位癌6例 ,喉黏膜角化症 2 1例。 4例喉乳头状瘤患者曾行喉裂…     

喉内镜下低温等离子射频治疗声带息肉疗效观察

目的评估喉内镜下低温等离子射频治疗声带息肉的疗效,探讨动态喉镜在声带息肉手术中的应用。方法 2008年9月~2010年10月采用喉内镜下低温等离子射频治疗声带息肉85例,术后3个月观察治疗效果,利用德国X ION电子动态喉镜检查,并用配套喉记波扫描软件采集喉记波图像,对其特征进行分析。结果 85例患者中,81例声带手术创面平整光滑,无组织残留,黏膜波基本正常,声音一般在1~3个月恢复正常;3例术后发音功能明显改善;1例患者声带前端有息肉残留,半年后接受再次手术。结论低温等离子射频具有微创、出血少、安全、并发症少等特点,在喉内镜下用其治疗声带息肉效果良好,此技术应用前景广阔。     

支撑喉内镜电视显示系统下手术治疗喉部病变

继鼻内镜手术和耳内镜手术之后 ,喉内镜手术治疗喉部病变同样具有优越性。我们从 2 0 0 2年 8月以来采用支撑喉内镜电视显示系统下手术治疗喉部病变 35例 ,取得了良好的效果。一、临床资料1 使用设备 :桐庐尖端医疗器械厂支撑喉内镜电视显示系统以及德国RUDOLF电视显示系统。内镜为 0°和 10°。2 患者 35例 :男性 2 7例 ,女性 8例 ;年龄 8～ 5 8岁。声带息肉 (单侧或双侧 ) 2 1例 ,声带小结 6例 ,声带血管瘤 1例 ,肥厚性喉炎 4例 ,炎性增生性病变 3例。二、手术方法和结果一律采用全身麻醉 ,口腔插管 ,仰卧位 ,不垫肩。常规消毒后 ,上…     

DNA content in laryngeal keratosis, laryngeal cancer and normal laryngeal epithelium

The DNA content in laryngeal precancerous lesion, laryngeal keratosis, laryngeal carcinoma and normal laryngeal epithelium had been measured in order to study the relationship between histopathologic picture and DNA content. The results showed that the DNA content in keratotic tissue increased to varying degrees as compared with the normal tissue. The DNA content in laryngeal cancer increased distinctly, being much higher than that in normal and keratotic tissues.     

Reflex control on laryngeal functions--vibration effect of the laryngeal mucosa on recurrent laryngeal nerve reflexes

Electromyographic (EMG) responses of the intrinsic laryngeal muscle have been investigated to clarify reflexogenic laryngeal controls from a viewpoint of its functional significance during phonation. Twenty-five adult cats were anesthetized with intraperitoneal injection of 4ml/kg of a mixture of 10% urethane and 1% alpha-chloralose. Either the internal branch of the superior laryngeal nerve (ISLN) or the recurrent laryngeal nerve (RLN) was carefully dissected and central end of the dissected nerve was electrically stimulated. EMG of the contra-lateral Thyro-Arytenoid muscle (TA muscle) to the stimulation was recorded using a hooked-wire electrode inserted through the laryngeal mucosa. EMG of the TA muscle evoked by the stimulation of the ISLN were analyzed with respect to its latency and discharge pattern inter-collicular brainstem transsected. Together with the stimulation of the RLN, vibratory stimuli were given mainly to the subglottic mucosa as conditioning stimuli. The vibratory frequency was changed from 50Hz to 400Hz step-wisely. Following results were obtained. 1. EMG response of the contra-lateral TA muscle to the stimulation of the ISLN showed two different kinds of latency, approximately 8-10msec, and 40-60msec. 2. After inter-collicular brainstem transsection, evoked response of the latter disappeared. This result indicates that the ISLN-RLN reflex loop consisted of more than two routes, different in the number of synaptic junctions. 3. The vibratory stimuli given to the laryngeal mucosa had facilitatory effect on the reflexive EMG response evoked by the stimulation of the RLN. 4. This facilitatory effect of the vibratory stimuli disappeared after topical anesthesia of the laryngeal mucosa. 5. The facilitatory effect on the reflex responses was partially increased depending on the vibratory frequencies applied. In conclusion, vibratory stimuli to the laryngeal mucosa reflexively modulate the activity of the intrinsic laryngeal muscles.     

Three-dimensional laryngeal model for planning of laryngeal framework surgery

CONCLUSION: The three-dimensional prototype model was useful for planning of laryngeal framework surgery. OBJECTIVE: To discuss the usefulness of a three-dimensional laryngeal model for laryngeal framework surgery. MATERIALS AND METHODS: A three-dimensional laryngeal model was created based on the postoperative helical computed tomography (CT) data of the larynx (case 1) which underwent lateral cricoarytenoid muscle (LCA) pull surgery. LCA pull surgery is a kind of arytenoid adduction for unilateral vocal cord paralysis. A three-dimensional model of case 1 larynx was prototyped using a selective laser sintering method. In case 1, the patient's voice did not improve after LCA pull surgery. The three-dimensional model revealed that the original surgical procedure was not appropriate to obtain optimal arytenoid adduction. According to the analysis of this three-dimensional model, we changed the surgical approach and performed this new refined LCA pull surgery on another patient with unilateral vocal cord paralysis (case 2). RESULTS: We were able to pull LCA precisely in case 2. Three-dimensional CT of case 2 after refined LCA pull surgery allowed the correct pulling of LCA and complete adduction of arytenoid. The postoperative voice improved remarkably.     

保留功能的喉癌手术70例报告

目的 :探讨喉部分切除术治疗声门型、声门上型喉癌的远期疗效和功能恢复。方法 :对 1978年 7月～1998年 8月间手术的 70例临床资料进行总结和随访。其中声门型喉癌 6 0例、声门上型喉癌 10例 ;施行喉裂开声带切除术 2 2例 ,垂直半喉切除术 2 2例 ,Majer- Piquet手术 17例 ,水平半喉切除术 7例 ,Arslan手术 2例。结果 :1、3及 5年生存率分别为 98.5 3%、87.0 4%和 78.2 6 %。拔管率为 10 0 %。全部病例恢复经口进食 ,一经拔管均能发音。并发症发生率和术后复发率各为 15 .71%和 13.0 4%。结论 :喉部分切除术是功能保全性喉部恶性肿瘤根治的有效术式。它在切除肿瘤、延长生命的同时可以较好地保留喉的生理功能 ,提高患者术后的生活质量     

Magnesium content of laryngeal precancerous conditions and laryngeal cancers

The content of magnesium in tissues, erythrocytes and serum was analysed by atomic absorption spectrometry. A higher concentration of magnesium was found in malignant laryngeal tissue and in lymph nodes of the neck compared to homologous pre-cancerous tissue. In pre-cancerous lesions of the larynx the magnesium concentration of the erythrocytes and serum lay at the lower limit of normal. In patients with cancer of the larynx, the magnesium concentration was considerably below the normal levels and continued to decline as the disease progressed.     

Three-dimensional laryngeal model for planning of laryngeal framework surgery

Conclusion. The three-dimensional prototype model was useful for planning of laryngeal framework surgery. Objective: To discuss the usefulness of a three-dimensional laryngeal model for laryngeal framework surgery. Materials and methods. A three-dimensional laryngeal model was created based on the postoperative helical computed tomography (CT) data of the larynx (case 1) which underwent lateral cricoarytenoid muscle (LCA) pull surgery. LCA pull surgery is a kind of arytenoid adduction for unilateral vocal cord paralysis. A three-dimensional model of case 1 larynx was prototyped using a selective laser sintering method. In case 1, the patient's voice did not improve after LCA pull surgery. The three-dimensional model revealed that the original surgical procedure was not appropriate to obtain optimal arytenoid adduction. According to the analysis of this three-dimensional model, we changed the surgical approach and performed this new refined LCA pull surgery on another patient with unilateral vocal cord paralysis (case 2). Results. We were able to pull LCA precisely in case 2. Three-dimensional CT of case 2 after refined LCA pull surgery allowed the correct pulling of LCA and complete adduction of arytenoid. The postoperative voice improved remarkably.     

喉返神经麻痹的肌电特点及相关研究

目的：研究喉返神经麻痹患者不同时间和损伤程度的喉肌电特点。方法：根据发病时间将87例喉返神经麻痹患者分为7组,分析其喉肌电特点,并与30例正常受试者进行对比研究。结果：①发病2周时,最早5d在受累甲杓肌、环杓后肌和环杓侧肌即可出现纤颤波和正锐波等失神经电位;2周-3个月失神经电位增多,可见再生电位;3个月后失神经电位渐少,再生电位渐多;36个月后失神经电位消失。②受累喉肌肌电募集减弱甚至无明显干扰相,干扰相波幅和转折数显著低于正常对照组,其中转折数减低更为明显,未受累喉肌募集电位明显增大。③部分患者受累喉肌诱发电位消失,其他患者可见波幅小、潜伏期长的诱发电位。结论：喉肌电图对于喉返神经麻痹的诊断和鉴别具有重要意义,失神经电位和再生电位特点与神经损伤的程度和时间相关,异常的诱发电位可提示神经损伤的程度。     

Spasmodic laryngeal dyspnea: a rare manifestation of laryngeal dystonia

We describe clinical experiences in the management of three patients with laryngopharyngeal dystonia causing severe breathing problems. In contrast to spasmodic dysphonia, which presents with action-induced involuntary spasms of laryngeal muscles during speaking, all three patients showed laryngopharyngeal spasms primarily during respiration. In analogy to spasmodic dysphonia we propose the term spasmodic laryngeal dyspnea for this rare condition. Localized unilateral botulinum toxin injected into the thyroarytenoid muscle and /or ventricular folds reduced the quantity and quality of spasms and led to a pronounced improvement of breathing problems.     

Effect of deficits in laryngeal sensation on laryngeal muscle biochemistry

Swallowing deficits in elderly people are significant clinical problems and may be associated with impaired pharyngolaryngeal sensation. However, the extent to which sensory innervation affects the motor system is unclear. Our purpose was to examine differences in biochemical properties of laryngeal muscles following sensory nerve ablation. We used sodium dodecyl sulfate-polyacrylamide gel electrophoresis to evaluate laryngeal muscles of young and old Fischer 344/Brown Norway rats, and rats that underwent sensory ablation via bilateral section of the superior laryngeal nerve, internal branch (SLNi), or mixed sensory-motor nerve ablation via left-sided recurrent laryngeal nerve (RLN) section. In lateral thyroarytenoid muscle, a reduction was found in the proportion of the most rapidly contracting myosin heavy chain isoform (type 2B) with SLNi section, RLN section, and aging. Section of the SLNi did not alter the proportion of any myosin heavy chain isoform within the lateral cricoarytenoid or posterior cricoarytenoid muscles, but RLN section resulted in a reduction in the proportion of type 2B. Accordingly, alteration in biochemical properties of the lateral thyroarytenoid muscle alone was demonstrated following sensory ablation. We conclude that sensory changes may affect properties of laryngeal muscles, and may thus have an impact on motor control during critical functions, such as airway protection during swallowing.