支撑喉镜喉显微外科手术的麻醉(附84例报告)

目的探讨支撑喉镜喉显微外科手术与麻醉的关系.方法回顾分析84例于全麻支撑喉镜下显微外科手术的麻醉情况.结果84例均完整切除喉部病灶.环甲膜穿刺组2例穿刺针滑脱,气管插管组和塑料喷射管组未发生并发症.结论塑料喷射管经鼻置入声门下喷射通气优于环甲膜穿刺和气管插管麻醉,安全、方便、操作简单、并发症少.     

塑料喷射管经鼻置入声门下喷射通气麻醉用于喉显微外科手术

支撑喉镜下喉显微外科手术要求声带固定 ,术野清晰有充分时间观察喉的病变和进行精细的手术操作。这只能在全麻下使用肌松药物使喉头松弛、自主呼吸停止。声门完全开放方能达到目的。我们曾采用穿刺针经环甲膜穿刺进行声门下喷射通气 ,但因为有穿刺损伤和喷射针滑脱后造成严重的皮下气肿的危险而停止使用。 1999年 2月以来我们用半硬质 (内径为1.5 mm)的细塑料导管经鼻置入声门下进行喷射通气取得良好效果 ,现报告如下。1　资料与方法择期在支撑喉镜下行喉显微外科手术病人 2 2例 ,男 13例 ,女 9例 ,年龄 36 .2± 6 .7岁 ,体重 6 2 .3± 8.2…     

自制加长电刀在功能性喉微创手术中的应用

目的探讨自制加长电刀在支撑喉镜下行功能性喉微创手术的应用价值，以及手术方法。方法对38例常见喉部疾病的住院患者，在全麻显微支撑喉镜下，应用自制加长电刀行喉部病灶切除术。结果7例早期声带癌患者，1例术后1年局部复发，再行垂直半喉切除术，随访至今（2年）未见复发；其余6例未见局部复发和淋巴结转移。31例良性病变及癌前病变患者均一次手术成功。     

2种不同方式的声带囊肿手术比较

目的:比较声带囊肿电子喉镜下切除和支撑喉镜下显微切除的疗效.方法:电子喉镜及频闪喉镜确诊为声带囊肿的患者92例,随机分为电子喉镜手术组48例及支撑喉镜手术组44例,术前及术后1周、3个月及6个月行电子喉镜检查及嗓音测试.结果:支撑喉镜手术组1例声门暴露不佳,改为电子喉镜下手术.其余均一次性完成手术.电子喉镜组和支撑喉镜组3个月内复发的病例分别是2例和1例,经X2检验,差异无统计学意义(P＞0.05).2组术前及术后1周、3个月及6个月嗓音声学测试经t检验均差异无统计学意义(均P＞0.05).结论:电子喉镜下声带囊肿切除具有视野清晰,操作准确,创伤小,兼有对喉部病变放大作用,能达到支撑喉镜下声带囊肿显微手术相同疗效,电子喉镜还能完成支撑喉镜下无法进行的声带囊肿手术.     

显微缝合技术在喉显微外科手术中的应用

目的:探讨显微缝合技术在喉显微外科手术中的应用价值。方法:对61例喉部良性疾病患者在全身麻醉支撑喉镜下切除病变后采用显微黏膜缝合技术,对切除病变后黏膜创缘进行间断缝合。结果:术后喉内黏膜愈合时间明显缩短,声音改善,瘢痕减少,粘连减轻。结论:在喉显微外科手术中应用显微缝合技术可提高手术疗效,改善喉功能。     

显微支撑喉镜下钬激光治疗喉部肿瘤及喉瘢痕狭窄8例

目的 探讨显微支撑喉镜下应用钬激光治疗喉部肿瘤及喉瘢痕狭窄的临床疗效。方法 8例喉部肿瘤及喉瘢痕狭窄患者,均在全麻下行显微支撑喉镜下钬激光手术治疗,术后随访6～12个月。结果 8例中喉癌4例,术后随诊6～12个月发音基本满意,无复发;喉癌术后喉狭窄3例,随诊6～12个月未发生再次狭窄;喉乳头状瘤1例,随诊8个月无复发。结论 对喉部良性肿瘤、早期喉癌及喉气管狭窄等病变行显微支撑喉镜下钬激光手术,具有手术创伤小、患者恢复快、术后并发症较少等特点。     

全麻显微支撑喉镜下声带息肉手术前后护理流程

目的 探讨全麻显微支撑喉镜下声带息肉切除手术前术后科学有效的护理流程.方法 总结回顾156例全麻显微支撑喉镜下声带息肉切除手术的术前检查、心理辅导、手术方法和效果、手术并发症,术后检查,术后康复指导和嗓音训练.结果 ①术前电子喉镜下声带检查;声带带蒂息肉45例、广基息肉111例,左侧声带病变49例、右侧病变42例、双侧病变65例.②术前心理辅导:对手术有恐惧感97例、辅导后解除95例.③术前牙齿松动与颈部僵直的检查:上切牙松动12例、头颈部后仰小于45度8例.④手术结果:术后电子喉镜检查声带息肉残留2例、声带肌及周边损伤1例,术中因头颈部后仰小于45度支撑喉镜插入困难6例,术中牙齿脱落1例,术中咽部黏膜擦伤15例.⑤术后发声训练:术后24/小时开始进行发声训练,能按正确的训练进行发声无声音嘶哑36例,术后72小时后可以按正确方法发声无声音嘶哑31例.⑥术后嗓音分析:发元音/a/的声学检测结果:与术前比较Jitt、Shim、NHR:均与术前有明显差异,P<0.01.⑦术后半年和半年以上随访电子喉镜结果:无声带息肉复发150例,占96.1％,声带息肉复发再次手术4例,占2.5％.结论①全麻显微支撑喉镜下声带息肉切除术前、术后科学有效的治疗和护理流程,提高了治疗效果、降低了手术复发率.②术前术后的电子镜声带检查和嗓音检查、分析、以及术后的嗓音康复训练纳入护理工作流程,进一步提高了护理质量和临床治疗效果.     

支撑喉镜联合腹腔镜声带息肉及任克水肿的手术初探

目的 探索支撑喉镜联合腹腔镜下手术治疗声带息肉与任克水肿的可行性,评价该术式临床应用的优点.方法 2006年6月～2008年1月,在全麻下经支撑喉镜联合12°直径4 mm腹腔镜监视系统对52例声带息肉患者和12例任克水肿患者实施声带手术,观察手术效果.结果 所有病例均一次性治愈,发声良好,随访10个月以上无复发.结论 通过支撑喉镜联合腹腔镜监视系统直视下行声带病变手术,术野大,利于彻底切除病灶和保护正常声带组织.     

全麻显微支撑喉镜下声带手术135例疗效分析

目的：观察全麻显微支撑喉镜下声带息肉、小结、白斑、囊肿摘除术后的临床疗效。方法: 回顾性分析我院135例相关患者的临床资料,术前均行纤维喉镜检查,术后常规病理分析,随访0.5～7.0年。 结果：121例患者声带息肉中118例术后2周发音恢复正常,3例因手术创面较大发音恢复稍差。声带小结、白斑、囊肿患者随访半年以上无复发,总治愈率97.78%。结论：全麻显微支撑喉镜下手术对声带局限性病变切除彻底,复发率低。     

喉部血管肉瘤一例

本文报道了我科收治的1例喉部血管肉瘤病例。患者老年男性,以声音嘶哑3年余入院,入院初步诊断为喉部新生物,术前病理提示:右侧声带考虑假肉瘤性改变。在全麻下经支撑喉镜CO2激光声带新生物切除术,术后病理示声带血管肉瘤,再次在全麻下经支撑喉镜CO2激光喉部分切除术,密切随访16个月无复发。     

支撑喉镜下喉显微手术患者的体位改进

目的 探讨嗅物位对支撑喉镜下喉显微手术术野暴露的优势。 方法 选择拟行支撑喉镜下喉显微手术的嗓音疾病患者60例,随机分为嗅物位组(A组)及去枕仰卧位组(B组)2组,每组30例。A组患者予以枕下垫自制头枕,肩背部紧贴于手术台面,再将其头部伸展于寰枕关节;B组患者摆放去枕仰卧位。评价声门暴露情况,根据声带病变范围及性质行喉显微手术。 结果 (1)暴露声门耗时:A组(2.42±1.04)min明显短于B组(3.20±0.95)min,两组比较差异具有统计学意义(P<0.05);(2)手术并发症:A组术后喉部疼痛VAS评分低于B组,两组比较差异具有统计学意义(P<0.05);A组术后咽喉部黏膜损伤发生率(6.7%)明显低于B组(30.0%),术后舌部麻木及术中术后牙齿损伤情况基本无发生,与B组比较,术后恢复良好、手术并发症少。 结论 嗅物位较去枕仰卧位更有利于支撑喉镜下的声门暴露,耗时更短、手术并发症更少。     

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。     

两种不同方式的声带息肉手术比较

目的比较全麻显微支撑喉镜和表麻电子喉镜下声带息肉摘除优缺点及术后的疗效.方法选取我院门诊声带息肉患者72例,随机分为两组,一组行支撑喉镜手术,另一组行电子喉镜手术,每组36例,每例患者均在术前及术后1月行电子喉镜检查及嗓音声学测试.结果支撑喉镜手术组一次性完成手术33例,改用电子喉镜下手术2例,需电子喉镜补充手术1例,电子喉镜手术组一次性完成手术35例,需2次完成手术1例.两组术后嗓音声学参数均明显优于手术前,统计学上差异有显著性意义(P＜0.05).结论电子喉镜下声带息肉摘除是微创手术,具有视野清晰、操作准确、创伤小、痛苦小、门诊手术、费用少等优点,能完成支撑喉镜下无法完成的手术,术后疗效和支撑喉镜下手术相仿.     

支撑喉镜下声带白斑显微手术39例

目的 探讨在支撑喉镜下显微手术治疗声带白斑的效果。方法 采用气管内插带气囊导管复合全麻,将带光源支撑喉镜沿麻醉导管自口腔缓慢插入,经咽腔到达喉。充分暴露声门后固定,调节显微镜至恰当倍数,镜下清除病变。 结果 术后随访1～10年,治愈及症状好转患者有效率为92.3%。结论 支撑喉镜下显微镜手术治疗声带白斑疗效良好。     

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。     

Indirect microlaryngostroboscopic surgery.

Detailed preoperative laryngostroboscopic examination is a prerequisite for phonosurgical correction of organic dysphonia. Although suspension microlaryngoscopic surgery has proved its value in the past, it excludes functional control during the removal of vocal fold swellings. Using an indirect microlaryngostroboscopic surgical technique with topical anesthesia, functional control can be achieved during surgery. This enables the removal of vocal fold swellings with a high degree of precision. Postoperative voice evaluation was performed in 31 patients after suspension microlaryngoscopic or indirect microlaryngostroboscopic surgery. The results showed that indirect microlaryngostroboscopic surgery is at least as good as, and in some respects even better than, suspension microlaryngostroboscopic surgery. Large vocal fold swellings, extensive Reinke's edema, and submucosal swellings are considered less suitable for indirect microlaryngostroboscopic surgery, because such lesions require bimanual instrumentation.     

支撑喉镜联合电子喉镜下平阳霉素注射治疗下咽及喉部血管瘤

目的探讨支撑喉镜联合电子喉镜下平阳霉素注射治疗下咽及喉部血管瘤的方法及疗效。方法分析2005年1月-2012年6月收治的下咽及喉部较大血管瘤患者22例,瘤体直径1.5-4.0 cm。均在全麻支撑喉镜下进行首次血管瘤体内注射平阳霉素,依据瘤体大小注射平阳霉素4-12 mg,注射6-8个点,首次注射后瘤体残留者改为在局麻电子喉镜下再次注射,直至治愈。结果支撑喉镜下一次治愈14例,8例瘤体残留,一次注射后残留瘤体平均直径缩小80%。8例残留患者电子喉镜下再注射1次后治愈5例,注射2次后治愈2例,注射3次后治愈1例,22例患者经随访1-3年,均未见复发。结论支撑喉镜联合电子喉镜下平阳霉素注射治疗下咽及喉部血管瘤具有微创、注射次数少、患者依从性好、疗效肯定等优点。     

Granuloma of the membranous vocal fold: an unusual complication of microlaryngoscopic surgery

OBJECTIVES: We describe the clinical features of granuloma of the membranous vocal fold (as opposed to granuloma of the vocal process, or "contact granuloma"), a poorly recognized sequela of microlaryngoscopic surgery. Membranous vocal fold granuloma may mimic the initial lesion in appearance, and thus be mistaken for recurrence. METHODS: We performed a retrospective review of cases from 2 institutions. RESULTS: Fifteen cases of membranous vocal fold granuloma from 2 institutions were identified. In all but 1 case, granuloma developed in the early postoperative period, within 8 weeks. Of the 15 cases, 10 followed laser resection of carcinoma. Five were noted following cold steel resection of benign lesions (2 papillomas, 2 cysts, 1 Reinke's edema). Technical aspects of these cases suggest that membranous vocal fold granulomas result from surgical violation of deep tissue planes and/or epithelial defects. All patients were treated with proton pump inhibitors. In 12 cases, the granulomas proved self-limited, resolving over weeks to months following surgery. Three patients underwent surgical removal of the lesion, which confirmed the diagnosis. One of these cases recurred and was treated nonsurgically. CONCLUSIONS: Granuloma should be suspected when a mass lesion appears at the surgical site early in the postoperative course. Surgical excision is generally not necessary and may provoke further growth of granulation tissue.     

Office-based 532-nm pulsed KTP laser treatment of glottal papillomatosis and dysplasia

OBJECTIVES: Treatment of glottal papillomatosis and dysplasia was mirror-guided and done in surgeons' offices in the 19th century. It migrated to the operating room in the 20th century to accommodate direct laryngoscopic surgery, which required assistants to administer anesthesia and procedural support. The primary treatment goals, which are disease regression and voice restoration and/or maintenance, are tempered by the morbidity of general anesthesia and potential treatment-induced vocal deterioration. To obviate general anesthesia, office-based laser laryngeal surgery was first done in 2001 with the 585-nm pulsed dye laser (PDL), because it employs a fiber delivery system and its energy is selectively absorbed by oxyhemoglobin. Since then, this new angiolytic laser treatment paradigm has become a mainstay of management for many surgeons; however, there are a number of shortcomings of the PDL. To further develop this concept and address the limitations of the PDL, we used a 532-nm pulsed potassium titanyl phosphate (KTP) laser. METHODS: A prospective assessment was performed on 48 patients in 72 cases of recurrent glottal dysplasia (36) or papillomatosis (36). All individuals had previously undergone microlaryngoscopic management with histopathologic evaluation. RESULTS: Two dysplasia patients did not tolerate the procedure. Of the treatable dysplasia cases, there was follow-up in 29 of 34. Disease regression was at least 75% in 18 of 29 cases (62%), 50% to 75% in 7 of 29 (24%), and 25% to 50% in the remaining 4 of 29 (14%). Papilloma patients returned for treatment when symptoms recurred, so disease regression could not be assessed accurately. Similar to data obtained with the PDL, these data confirmed that dysplastic mucosa could normalize without resection. CONCLUSIONS: Our observations revealed that the 532-nm pulsed KTP laser provided enhanced performance over the PDL laser in a number of ways. The ability to use smaller glass fibers precluded mechanical trauma to the channels of the flexible laryngoscopes and allowed for improved suctioning of secretions. Oxyhemoglobin absorbs energy better at 532 nm than at 585 nm, and the KTP laser can be delivered through a longer pulse width. These factors provide enhanced hemostasis and improved intralesional energy absorbance. Finally, unlike the PDL, the KTP laser is a solid-state laser and is not prone to mechanical failure.     

小儿喉尖锐湿疣43例临床分析

目的：探讨小儿喉尖锐湿疣的治疗方法。方法：对43例小儿喉尖锐湿疣进行手术治疗，26例在表面麻醉下行直接喉镜喉肿瘤切除术，17例在全身麻醉下行气管插管、支撑喉镜喉尖锐湿疣切除术，其中13例同时行疣组织上臂内侧皮下埋植术、干扰素声带黏膜下注射。结果：随访35例，痊愈26例，好转7例，死亡2例；其中，气管切开7例，拔管困难3例。结论：本病病变范围大，复发率高，应用支撑喉镜行喉肿瘤摘除术，疣组织上臂内侧皮下埋植术及干扰素辅助治疗，可更精确切除肿瘤和减少复发，避免气管切开术后拔管困难。