喉CO_2激光手术后声带粘连原因分析

目的:分析CO2激光手术治疗喉部疾病引起声带粘连的原因。方法:回顾性分析显微支撑喉镜下行喉部激光手术119例的临床资料。结果:119例患者中,双侧声带外展麻痹9例,声带息肉42例,喉癌前病变3例激光手术后均未引起声带粘连;喉狭窄5例中有1例,喉乳头状瘤41例中有5例,喉癌19例中有6例激光手术后出现声带粘连。结论:CO2激光手术通过选择合适的患者及手术部位,完善术中术后的处理,采用适宜的激光照射剂量,减少热辐射,可减少或避免显微喉镜激光手术引起的声带粘连。     

几丁糖预防CO2激光声带切除术后声带粘连短期观察的实验研究

目的 观察CO<,2>激光切除狗声带后局部涂布几丁糖预防声带粘连的效果.方法 17只狗中的16只被随机分成2组,以CO<,2>激光切除狗的双侧声带,几丁糖组和对照组分别立即于术后局部涂布几丁糖和生理盐水各5 min.术后1周于各组中随机抽取3只,以酶联免疫吸附法(ELISA)检测声带中的碱性成纤维细胞生长因子(basic fibroblast growth factor,bFGF)和转化生长因子(TGF)-β1的表达,并以透射电镜观察声带中成纤维细胞的超微结构.术后3周对余下的10只狗粘连的声带行CO<,2>激光松解,并再次分别局部涂布几丁糖和生理盐水各5 min.每周观察声带愈合和粘连形成过程,6周后收集所有的喉标本行组织学观察胶原表达.结果 电镜观察发现术后对照组狗声带较几丁糖组成纤维细胞内超微结构发达.术后1周几丁糖组声带中bFGF和TGF-β1的表达中位数[25分位数;75分位数]分别0.235[0.215;0.255]pg/mg和1.055[0.905;1.305]pg/mg,较对照组0.155[0.137;0.165]Pg/mg和0.820[0.687;0.962]ps/mg高,Wilcoxon秩和检验证实差异均有统计学意义(z值分别为-2.887和-2.005,P值分别为0.002和0.041).术后3周对照组声带粘连程度中位数为49%,几丁糖组为7%,Mann-Whitney U检验两组间声带粘连程度比较差异有统计学意义(z=-2.619,P=0.008).术后6周Mason染色见几丁糖组声带中胶原的表达较对照组轻,两组间胶原成分分值比较Fisher精确检验差异有统计学意义(P=0.023).结论几丁糖局部涂布能减轻狗CO<,2>激光声带切除术后声带的粘连.     

几丁糖预防CO2激光声带切除术后声带粘连短期观察的实验研究

Objective To observe the effect of immediate topical application of chitosan on preventing anterior giottic stenosis (AGS) after microsurgical resection of both vocal fold with CO<,2> laser , including the anterior commissure, in a canine model. Methods Sixteen canine larynges were injured by microresecting procedure of both vocal folds with CO<,2> laser. The dogs were randomly divided into two groups, chitosan group and control group. The chitosan and isotonic sodium chloride solution(control) were used for 5 minutes immediately after surgery. One week after the initial surgery, three dogs in each group were randomly selected , ultrastructure of fibroblast were examined with transmission electronic microscope and expression of basic fibroblast growth factor(bFGF) and traansforming growth factor betal (TGF-β1) were evaluated by enzyme-linked immunosorbent assay(ELISA). Three weeks after surgery, the rest dogs' glottic web were lysed and repeatedly treated with chitosan and isotonic sodium chloride solution respectively. The glottic wound healing and AGS formation were examined every week, and all larynges were harvested and examined histologically six weeks after the initial surgery. Results Transmission electronic microscope examination of the ultrasmcture of fibroblast indicated that chitosan inhibited the proliferation of fibroblast. Chitosan increased the expression of bFGF and TGF-β1, and bFGF and TGF-β1 in chitosan group, which was significantly higher than that in control group (z = -2.887 and -2.005, P =0.002 and 0.041). Chitosan decreased the extent of AGS formation. Three weeks after the surgery, the AGS lesion in the control group affected mean 49% of the length of the vocal folds from the anterior commissure to the vocal process, while chitosan group affected mean 7%, which was significantly less than the extent of web formation in the control group, (z = - 2. 619, P = 0. 008). The grade of collagen content in chitosan group was significantly lower than that in control group (P = 0. 003). Conclusion Chitosan is effective in preventing AGS after CO<,2> laser cordectomy.     

几丁糖预防CO2激光声带切除术后声带粘连短期观察的实验研究

Objective To observe the effect of immediate topical application of chitosan on preventing anterior giottic stenosis (AGS) after microsurgical resection of both vocal fold with CO<,2> laser , including the anterior commissure, in a canine model. Methods Sixteen canine larynges were injured by microresecting procedure of both vocal folds with CO<,2> laser. The dogs were randomly divided into two groups, chitosan group and control group. The chitosan and isotonic sodium chloride solution(control) were used for 5 minutes immediately after surgery. One week after the initial surgery, three dogs in each group were randomly selected , ultrastructure of fibroblast were examined with transmission electronic microscope and expression of basic fibroblast growth factor(bFGF) and traansforming growth factor betal (TGF-β1) were evaluated by enzyme-linked immunosorbent assay(ELISA). Three weeks after surgery, the rest dogs' glottic web were lysed and repeatedly treated with chitosan and isotonic sodium chloride solution respectively. The glottic wound healing and AGS formation were examined every week, and all larynges were harvested and examined histologically six weeks after the initial surgery. Results Transmission electronic microscope examination of the ultrasmcture of fibroblast indicated that chitosan inhibited the proliferation of fibroblast. Chitosan increased the expression of bFGF and TGF-β1, and bFGF and TGF-β1 in chitosan group, which was significantly higher than that in control group (z = -2.887 and -2.005, P =0.002 and 0.041). Chitosan decreased the extent of AGS formation. Three weeks after the surgery, the AGS lesion in the control group affected mean 49% of the length of the vocal folds from the anterior commissure to the vocal process, while chitosan group affected mean 7%, which was significantly less than the extent of web formation in the control group, (z = - 2. 619, P = 0. 008). The grade of collagen content in chitosan group was significantly lower than that in control group (P = 0. 003). Conclusion Chitosan is effective in preventing AGS after CO<,2> laser cordectomy.     

几丁糖预防CO2激光声带切除术后声带粘连短期观察的实验研究

Objective To observe the effect of immediate topical application of chitosan on preventing anterior giottic stenosis (AGS) after microsurgical resection of both vocal fold with CO<,2> laser , including the anterior commissure, in a canine model. Methods Sixteen canine larynges were injured by microresecting procedure of both vocal folds with CO<,2> laser. The dogs were randomly divided into two groups, chitosan group and control group. The chitosan and isotonic sodium chloride solution(control) were used for 5 minutes immediately after surgery. One week after the initial surgery, three dogs in each group were randomly selected , ultrastructure of fibroblast were examined with transmission electronic microscope and expression of basic fibroblast growth factor(bFGF) and traansforming growth factor betal (TGF-β1) were evaluated by enzyme-linked immunosorbent assay(ELISA). Three weeks after surgery, the rest dogs' glottic web were lysed and repeatedly treated with chitosan and isotonic sodium chloride solution respectively. The glottic wound healing and AGS formation were examined every week, and all larynges were harvested and examined histologically six weeks after the initial surgery. Results Transmission electronic microscope examination of the ultrasmcture of fibroblast indicated that chitosan inhibited the proliferation of fibroblast. Chitosan increased the expression of bFGF and TGF-β1, and bFGF and TGF-β1 in chitosan group, which was significantly higher than that in control group (z = -2.887 and -2.005, P =0.002 and 0.041). Chitosan decreased the extent of AGS formation. Three weeks after the surgery, the AGS lesion in the control group affected mean 49% of the length of the vocal folds from the anterior commissure to the vocal process, while chitosan group affected mean 7%, which was significantly less than the extent of web formation in the control group, (z = - 2. 619, P = 0. 008). The grade of collagen content in chitosan group was significantly lower than that in control group (P = 0. 003). Conclusion Chitosan is effective in preventing AGS after CO<,2> laser cordectomy.     

几丁糖预防CO2激光声带切除术后声带粘连短期观察的实验研究

Objective To observe the effect of immediate topical application of chitosan on preventing anterior giottic stenosis (AGS) after microsurgical resection of both vocal fold with CO<,2> laser , including the anterior commissure, in a canine model. Methods Sixteen canine larynges were injured by microresecting procedure of both vocal folds with CO<,2> laser. The dogs were randomly divided into two groups, chitosan group and control group. The chitosan and isotonic sodium chloride solution(control) were used for 5 minutes immediately after surgery. One week after the initial surgery, three dogs in each group were randomly selected , ultrastructure of fibroblast were examined with transmission electronic microscope and expression of basic fibroblast growth factor(bFGF) and traansforming growth factor betal (TGF-β1) were evaluated by enzyme-linked immunosorbent assay(ELISA). Three weeks after surgery, the rest dogs' glottic web were lysed and repeatedly treated with chitosan and isotonic sodium chloride solution respectively. The glottic wound healing and AGS formation were examined every week, and all larynges were harvested and examined histologically six weeks after the initial surgery. Results Transmission electronic microscope examination of the ultrasmcture of fibroblast indicated that chitosan inhibited the proliferation of fibroblast. Chitosan increased the expression of bFGF and TGF-β1, and bFGF and TGF-β1 in chitosan group, which was significantly higher than that in control group (z = -2.887 and -2.005, P =0.002 and 0.041). Chitosan decreased the extent of AGS formation. Three weeks after the surgery, the AGS lesion in the control group affected mean 49% of the length of the vocal folds from the anterior commissure to the vocal process, while chitosan group affected mean 7%, which was significantly less than the extent of web formation in the control group, (z = - 2. 619, P = 0. 008). The grade of collagen content in chitosan group was significantly lower than that in control group (P = 0. 003). Conclusion Chitosan is effective in preventing AGS after CO<,2> laser cordectomy.     

几丁糖预防CO2激光声带切除术后声带粘连短期观察的实验研究

Objective To observe the effect of immediate topical application of chitosan on preventing anterior giottic stenosis (AGS) after microsurgical resection of both vocal fold with CO<,2> laser , including the anterior commissure, in a canine model. Methods Sixteen canine larynges were injured by microresecting procedure of both vocal folds with CO<,2> laser. The dogs were randomly divided into two groups, chitosan group and control group. The chitosan and isotonic sodium chloride solution(control) were used for 5 minutes immediately after surgery. One week after the initial surgery, three dogs in each group were randomly selected , ultrastructure of fibroblast were examined with transmission electronic microscope and expression of basic fibroblast growth factor(bFGF) and traansforming growth factor betal (TGF-β1) were evaluated by enzyme-linked immunosorbent assay(ELISA). Three weeks after surgery, the rest dogs' glottic web were lysed and repeatedly treated with chitosan and isotonic sodium chloride solution respectively. The glottic wound healing and AGS formation were examined every week, and all larynges were harvested and examined histologically six weeks after the initial surgery. Results Transmission electronic microscope examination of the ultrasmcture of fibroblast indicated that chitosan inhibited the proliferation of fibroblast. Chitosan increased the expression of bFGF and TGF-β1, and bFGF and TGF-β1 in chitosan group, which was significantly higher than that in control group (z = -2.887 and -2.005, P =0.002 and 0.041). Chitosan decreased the extent of AGS formation. Three weeks after the surgery, the AGS lesion in the control group affected mean 49% of the length of the vocal folds from the anterior commissure to the vocal process, while chitosan group affected mean 7%, which was significantly less than the extent of web formation in the control group, (z = - 2. 619, P = 0. 008). The grade of collagen content in chitosan group was significantly lower than that in control group (P = 0. 003). Conclusion Chitosan is effective in preventing AGS after CO<,2> laser cordectomy.     

几丁糖预防CO2激光声带切除术后声带粘连短期观察的实验研究

Objective To observe the effect of immediate topical application of chitosan on preventing anterior giottic stenosis (AGS) after microsurgical resection of both vocal fold with CO<,2> laser , including the anterior commissure, in a canine model. Methods Sixteen canine larynges were injured by microresecting procedure of both vocal folds with CO<,2> laser. The dogs were randomly divided into two groups, chitosan group and control group. The chitosan and isotonic sodium chloride solution(control) were used for 5 minutes immediately after surgery. One week after the initial surgery, three dogs in each group were randomly selected , ultrastructure of fibroblast were examined with transmission electronic microscope and expression of basic fibroblast growth factor(bFGF) and traansforming growth factor betal (TGF-β1) were evaluated by enzyme-linked immunosorbent assay(ELISA). Three weeks after surgery, the rest dogs' glottic web were lysed and repeatedly treated with chitosan and isotonic sodium chloride solution respectively. The glottic wound healing and AGS formation were examined every week, and all larynges were harvested and examined histologically six weeks after the initial surgery. Results Transmission electronic microscope examination of the ultrasmcture of fibroblast indicated that chitosan inhibited the proliferation of fibroblast. Chitosan increased the expression of bFGF and TGF-β1, and bFGF and TGF-β1 in chitosan group, which was significantly higher than that in control group (z = -2.887 and -2.005, P =0.002 and 0.041). Chitosan decreased the extent of AGS formation. Three weeks after the surgery, the AGS lesion in the control group affected mean 49% of the length of the vocal folds from the anterior commissure to the vocal process, while chitosan group affected mean 7%, which was significantly less than the extent of web formation in the control group, (z = - 2. 619, P = 0. 008). The grade of collagen content in chitosan group was significantly lower than that in control group (P = 0. 003). Conclusion Chitosan is effective in preventing AGS after CO<,2> laser cordectomy.     

几丁糖预防CO2激光声带切除术后声带粘连短期观察的实验研究

Objective To observe the effect of immediate topical application of chitosan on preventing anterior giottic stenosis (AGS) after microsurgical resection of both vocal fold with CO<,2> laser , including the anterior commissure, in a canine model. Methods Sixteen canine larynges were injured by microresecting procedure of both vocal folds with CO<,2> laser. The dogs were randomly divided into two groups, chitosan group and control group. The chitosan and isotonic sodium chloride solution(control) were used for 5 minutes immediately after surgery. One week after the initial surgery, three dogs in each group were randomly selected , ultrastructure of fibroblast were examined with transmission electronic microscope and expression of basic fibroblast growth factor(bFGF) and traansforming growth factor betal (TGF-β1) were evaluated by enzyme-linked immunosorbent assay(ELISA). Three weeks after surgery, the rest dogs' glottic web were lysed and repeatedly treated with chitosan and isotonic sodium chloride solution respectively. The glottic wound healing and AGS formation were examined every week, and all larynges were harvested and examined histologically six weeks after the initial surgery. Results Transmission electronic microscope examination of the ultrasmcture of fibroblast indicated that chitosan inhibited the proliferation of fibroblast. Chitosan increased the expression of bFGF and TGF-β1, and bFGF and TGF-β1 in chitosan group, which was significantly higher than that in control group (z = -2.887 and -2.005, P =0.002 and 0.041). Chitosan decreased the extent of AGS formation. Three weeks after the surgery, the AGS lesion in the control group affected mean 49% of the length of the vocal folds from the anterior commissure to the vocal process, while chitosan group affected mean 7%, which was significantly less than the extent of web formation in the control group, (z = - 2. 619, P = 0. 008). The grade of collagen content in chitosan group was significantly lower than that in control group (P = 0. 003). Conclusion Chitosan is effective in preventing AGS after CO<,2> laser cordectomy.     

几丁糖预防CO2激光声带切除术后声带粘连短期观察的实验研究

Objective To observe the effect of immediate topical application of chitosan on preventing anterior giottic stenosis (AGS) after microsurgical resection of both vocal fold with CO<,2> laser , including the anterior commissure, in a canine model. Methods Sixteen canine larynges were injured by microresecting procedure of both vocal folds with CO<,2> laser. The dogs were randomly divided into two groups, chitosan group and control group. The chitosan and isotonic sodium chloride solution(control) were used for 5 minutes immediately after surgery. One week after the initial surgery, three dogs in each group were randomly selected , ultrastructure of fibroblast were examined with transmission electronic microscope and expression of basic fibroblast growth factor(bFGF) and traansforming growth factor betal (TGF-β1) were evaluated by enzyme-linked immunosorbent assay(ELISA). Three weeks after surgery, the rest dogs' glottic web were lysed and repeatedly treated with chitosan and isotonic sodium chloride solution respectively. The glottic wound healing and AGS formation were examined every week, and all larynges were harvested and examined histologically six weeks after the initial surgery. Results Transmission electronic microscope examination of the ultrasmcture of fibroblast indicated that chitosan inhibited the proliferation of fibroblast. Chitosan increased the expression of bFGF and TGF-β1, and bFGF and TGF-β1 in chitosan group, which was significantly higher than that in control group (z = -2.887 and -2.005, P =0.002 and 0.041). Chitosan decreased the extent of AGS formation. Three weeks after the surgery, the AGS lesion in the control group affected mean 49% of the length of the vocal folds from the anterior commissure to the vocal process, while chitosan group affected mean 7%, which was significantly less than the extent of web formation in the control group, (z = - 2. 619, P = 0. 008). The grade of collagen content in chitosan group was significantly lower than that in control group (P = 0. 003). Conclusion Chitosan is effective in preventing AGS after CO<,2> laser cordectomy.     

几丁糖预防CO2激光声带切除术后声带粘连短期观察的实验研究

Objective To observe the effect of immediate topical application of chitosan on preventing anterior giottic stenosis (AGS) after microsurgical resection of both vocal fold with CO<,2> laser , including the anterior commissure, in a canine model. Methods Sixteen canine larynges were injured by microresecting procedure of both vocal folds with CO<,2> laser. The dogs were randomly divided into two groups, chitosan group and control group. The chitosan and isotonic sodium chloride solution(control) were used for 5 minutes immediately after surgery. One week after the initial surgery, three dogs in each group were randomly selected , ultrastructure of fibroblast were examined with transmission electronic microscope and expression of basic fibroblast growth factor(bFGF) and traansforming growth factor betal (TGF-β1) were evaluated by enzyme-linked immunosorbent assay(ELISA). Three weeks after surgery, the rest dogs' glottic web were lysed and repeatedly treated with chitosan and isotonic sodium chloride solution respectively. The glottic wound healing and AGS formation were examined every week, and all larynges were harvested and examined histologically six weeks after the initial surgery. Results Transmission electronic microscope examination of the ultrasmcture of fibroblast indicated that chitosan inhibited the proliferation of fibroblast. Chitosan increased the expression of bFGF and TGF-β1, and bFGF and TGF-β1 in chitosan group, which was significantly higher than that in control group (z = -2.887 and -2.005, P =0.002 and 0.041). Chitosan decreased the extent of AGS formation. Three weeks after the surgery, the AGS lesion in the control group affected mean 49% of the length of the vocal folds from the anterior commissure to the vocal process, while chitosan group affected mean 7%, which was significantly less than the extent of web formation in the control group, (z = - 2. 619, P = 0. 008). The grade of collagen content in chitosan group was significantly lower than that in control group (P = 0. 003). Conclusion Chitosan is effective in preventing AGS after CO<,2> laser cordectomy.     

几丁糖预防CO2激光声带切除术后声带粘连短期观察的实验研究

Objective To observe the effect of immediate topical application of chitosan on preventing anterior giottic stenosis (AGS) after microsurgical resection of both vocal fold with CO<,2> laser , including the anterior commissure, in a canine model. Methods Sixteen canine larynges were injured by microresecting procedure of both vocal folds with CO<,2> laser. The dogs were randomly divided into two groups, chitosan group and control group. The chitosan and isotonic sodium chloride solution(control) were used for 5 minutes immediately after surgery. One week after the initial surgery, three dogs in each group were randomly selected , ultrastructure of fibroblast were examined with transmission electronic microscope and expression of basic fibroblast growth factor(bFGF) and traansforming growth factor betal (TGF-β1) were evaluated by enzyme-linked immunosorbent assay(ELISA). Three weeks after surgery, the rest dogs' glottic web were lysed and repeatedly treated with chitosan and isotonic sodium chloride solution respectively. The glottic wound healing and AGS formation were examined every week, and all larynges were harvested and examined histologically six weeks after the initial surgery. Results Transmission electronic microscope examination of the ultrasmcture of fibroblast indicated that chitosan inhibited the proliferation of fibroblast. Chitosan increased the expression of bFGF and TGF-β1, and bFGF and TGF-β1 in chitosan group, which was significantly higher than that in control group (z = -2.887 and -2.005, P =0.002 and 0.041). Chitosan decreased the extent of AGS formation. Three weeks after the surgery, the AGS lesion in the control group affected mean 49% of the length of the vocal folds from the anterior commissure to the vocal process, while chitosan group affected mean 7%, which was significantly less than the extent of web formation in the control group, (z = - 2. 619, P = 0. 008). The grade of collagen content in chitosan group was significantly lower than that in control group (P = 0. 003). Conclusion Chitosan is effective in preventing AGS after CO<,2> laser cordectomy.     

丝裂霉素C在预防声带手术后前连合粘连中的作用

有报道[1]认为丝裂霉素C由于抑制成纤维细胞的增生,阻止成纤维细胞产生胶原物质而在鼻内镜手术中应用,能有效地抑制声带手术后鼻腔粘连.我们观察了在显微支撑喉镜下行双侧声带近前连合处病变切除时,局部应用丝裂霉素C涂布在预防前连合狭窄中的作用,现报告如下.     

声带脓肿1例

患者 ,男 ,5 2岁。因反复声嘶、喉痛 1年 ,再发1周入院。曾多次在外院检查均诊断为声带息肉 ,病历记录描述为黄豆大、花生米大不等。我院纤维喉镜检查发现右声带前部隆起一灰白色息肉样肿块 ,约 4.5ｍｍ× 5 .0ｍｍ大小 ,基底宽 ,表面光滑。声带活动可 ,闭合较差。于 2 0 0 1年 1 2月 1 3日在局麻加强化麻醉下行支撑喉镜声带肿块切除术。暴露声门后 ,先在德国Ｗｏｌｆ 0 ｏ 鼻内窥镜下仔细观察肿块 ,探之有囊性感。钳住肿块隆起部分 ,准备沿声带边缘剪切肿块时即有大量黄绿色脓样分泌物外溢 ,肿块随之消失。取分泌物送细菌培养 ,钳取小块囊…     

支撑喉镜下声带黏膜瓣法治疗声带良性病变术后声带粘连5例

目的　探索支撑喉镜下声带黏膜瓣法治疗声带良性病变术后声带粘连的临床疗效。方法　选取2015年6月~2017年6月亳州市人民医院收治的5例声带良性病变术后声带粘连患者,使用支撑喉镜下声带黏膜瓣法治疗声带粘连,随访1~2年观察治疗效果。结果　5例患者术后1、3、6个月嗓音嘶哑评估GRBAS评分各指标均较术前降低,差异有统计学意义（P＜0.01）;嗓音障碍严重指数（dysphonia severity index,DSI）术后评分较术前升高,标准化噪声能量、振幅微扰和基频微扰评分术后均较术前降低,差异均 有统计学意义（P 均＜0.05）。3例合并呼吸困难的患者术后呼吸困难完全缓解。结论　支撑喉镜下声带黏膜瓣法治疗声带粘连效果肯定,值得临床推广。     

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.     

声带颗粒细胞瘤1例

患者,男,45岁,持续性声嘶1年余,无呼吸困难,于2009年7月22日就诊.间接喉镜检查见左侧声带中份息肉样新生物,初诊为声带息肉.于7月28日全身麻醉行支撑喉镜下CO2激光声带息肉摘除术,术中见左侧声带前中1/3广基息肉样新生物,黄豆大小,质韧,表面光滑,钳除送病检,以CO2激光烧灼切除残余新生物.     

爆炸伤致支气管石块异物并声带麻痹1例

患者,男,29岁,被炸伤后间歇性咳嗽伴呼吸困难22d,于2005年1月27日入院。22d前患者在炸石过程中用右手持短棍检查哑炮时,雷管突然爆炸,致其右侧头面颈部及上肢被炸伤,伴昏迷,在当地医院急救并行清创缝合术。病情平稳后多次出现刺激性咳嗽并伴有呼吸困难,行气管切开术后上述症状仍不缓解。胸部X线片示右侧主支气管有一高密度异物,经纤维支气管镜发现为石块,拟取除未成功,后转我院。检查见气管套管已拔除,伤口未愈合,纤维支气管镜下见右侧声带麻痹,固定于旁正中位,距声门下3.0cm气管右侧壁有一长约2.0cm纵形缺损,肉芽组织封闭,右侧主支气管内…     

喉显微激光术后声带粘连的治疗和预防

目的　探讨内镜下喉内置入非聚氯乙烯（polyvinyl chloride,PVC）喉膜治疗和预防双侧声带粘连的临床疗效。方法　收集2013年1月～2017年9月在我科行CO2激光喉显微手术后喉腔置入非PVC喉膜治疗和预防声带粘连的25例患者临床资料,其中16例（治疗组）双侧声带病变术后4～13个月声带粘连患者（严重程度为II～Ⅳ级,均未累及声门下）,行CO2激光分离粘连后喉外法喉膜置入;9例（预防组）前连合病变和累及前连合的双侧声带病变患者,行CO2激光切除病变,术中喉外法同期行喉膜置入预防术后声带粘连或喉狭窄。上述25例患者术前术后均行主观嗓音质量评估。术后4周左右取出喉膜,至少随访12个月,观察术后声门形态及临床疗效。结果　治疗组16例患者中,有效13例（81.25%）,无效3例（18.75%）。预防组9例一期喉膜置入预防声带粘连患者中,有效6例（66.67%）,无效3例（33.33%）。治疗组术后嗓音障碍指数较术前明显改善（P <0.01）,两组术后均无明显并发症。结论　内镜下喉外法喉内植入非PVC喉膜是治疗和预防声带粘连的有效方法,值得推广应用。