支撑喉镜显微喉手术的麻醉方法选择

本文对比观察在气管内插管、高频喷射给氧、静脉复合麻醉和强化表面麻醉下行支撑喉镜显微喉手术的结果。认为后一种方法吴有许多优点，但并不能取代前一种方法，二者的选用应灵活掌握，相互补充。     

间接显微喉动态镜手术

目的　介绍间接显微喉动态镜手术治疗声带良性病变的方法并总结临床经验。方法　在表面麻醉间接喉镜下,通过与喉动态镜频闪光源连接的手术显微镜切除声带良性病变５０ 例。结果　效果满意,治愈率９２ ％ ,未发生并发症。结论　间接显微喉动态镜手术具有安全、声带功能恢复良好等优点,是治疗声带良性病变的较好的手术方法之一     

支撑喉镜下喉显微手术气管插管的麻醉处理

支撑喉镜下喉显微手术时间短,但安置喉镜时窦性心动过缓发生率高,福建省厦门市174医院麻醉科采用1%丁卡因咽喉腔黏膜表面麻醉,收到较好的效果,现报道如下。     

支撑喉镜手术护齿架的研制与应用

支撑喉镜下喉显微手术应用广泛 ,但并发症时有发生 ,其中之一是造成上列牙的松动或压脱以及牙床的损伤 ,甚至引起医疗纠纷。为了减少此类并发症的发生 ,笔者设计制作了一种结构简单、使用方便的支撑喉镜护齿架 ,适用于任何年龄 ,可保护上列牙不受任何损伤 ,现介绍如下。1　材料与制作本装置采用金属材料 ,由底座固定钢板 (1块 )、升降螺干 (2个 )、拱形支架 (1个 )、螺母 (8个 )组成。底座固定钢板长 40 .0cm ,宽 1 0 .0cm ,厚0 .2cm ;螺干长 2 0 .0cm ,直径 0 .5cm ;拱形支架长40 .0cm ,宽 2 .0cm ,厚 0 .1cm。在距离底座固定钢板两端中央 …     

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。     

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。     

支撑喉镜下显微手术治疗声带良性病变的疗效分析

目的探讨应用支撑喉镜显微手术治疗声带良性病变的方法和疗效。方法回顾性分析诊治的158例声带良性病变患者进行支撑喉镜显微手术的临床资料。结果 158例声带良性病变患者,经支撑喉镜喉显微手术治疗,治愈136例,治愈率为86.1%;好转15例,占9.5%,总有效率96%。并发软腭擦伤及黏膜下淤血10例(6.33%)、舌体麻木13例(8.23%),均短期内恢复;上切牙松动5例(3.16%)。所有患者术后随访3个月至1年,无复发。结论支撑喉镜显微镜术能提供清晰声带图像,能分辨细小病变,切除病变彻底精细,适合于各种声带良性病变切除。但费用高,少数可出现软腭黏膜损伤、舌体麻木等并发症。     

支撑喉镜下喉显微手术后并发半侧舌麻痹4例报告

在全身麻醉下将显微镜与支撑喉镜或悬吊喉镜结合 ,行声带良性肿物 (广基声带息肉、小结、肥厚、囊肿、白斑、喉室病变等 )及早期恶性肿瘤切除 ,近 1 0年在国内已广泛开展。因其固定喉镜系在全麻成功后经口腔、咽部插至声门处 ,故与此有关的主要并发症有 :咽粘膜挫伤、软腭擦伤、喉水肿、切牙松动压脱、颞颌关节功能障碍、颈部皮下气肿等。我科自 1 995年开展这一手术以来 ,并发半侧舌肌麻痹 3例 ,半侧舌肌萎缩 1例 ,均为少见并发症 ,现报告如下。1　临床资料4例并发症中 ,男 2例 ,女 2例 ;年龄 37～ 46岁。声嘶病程 0 .5～ 2年。 2例男性均…     

可视喉镜在声门暴露困难患者喉显微手术中的应用

目的探讨可视喉镜在声门暴露困难患者喉显微手术中的应用价值。方法回顾性分析2016年1月~2016年8月在我院采用可视喉镜辅助喉显微手术治疗的20例声门暴露困难的声带良性病变患者的临床资料,对患者的平均手术时间、术中平均出血量、术中牙齿松动发生率、软腭裂伤发生率以及术后疼痛评分进行分析。结果根据Cormack Lehane(C L)分级方法,20例患者中属于III级声门暴露困难者15例,IV级声门暴露困难者5例。所有患者的平均手术时间、术中平均出血量、术中牙齿松动发生率、软腭裂伤发生率以及术后疼痛平均评分分别为(17.20±3.33)min、(3.30±1.17)ml、0%（0/20）、0%（0/20）及(1.35±0.93)分。术后随访3~6个月,患者均无复发。结论可视喉镜在普通支撑喉镜下声门暴露困难患者的喉显微手术中声门暴露充分,手术时间短且围手术期并发症少,值得推广应用。     

间接显微频闪喉镜手术

随着光导纤维的发展,近年来喉内窥镜手术发展甚快,但以间接显微手术与频闪喉镜结合进行声带手术,目前国内尚无报道。本文以间接显微频闪喉镜,对３３例声带息肉进行了手术摘除,现就此手术的国外发展动态、手术特点、手术器械、操作要点、术式的优缺点及临床实用价值客观的对比分析。     

支气管潜窥镜在喉显微手术中的应用

目的探讨支气管潜窥镜下行喉显微手术的可行性.方法全麻支撑喉镜下应用支气管潜窥镜Hopkings     

显微喉镜手术中三种麻醉方法的选择

目的 探讨支撑喉镜下喉显微手术对麻醉方法的选择。方法 应用带气囊导管（Ｆ２４）气管内播管麻醉（Ａ组）,不带气囊小导管（Ｆ１６）气管内插管并高频喷射给氧麻醉（Ｂ组）和强化表面麻醉（Ｃ组）三种麻醉方法分别对３１９例喉部良性增生性疾病患者行显微喉镜手术。并对三种不同麻醉方法手术中的效果和并发症进行对比观察。结果 发现三种麻醉方法的并发症发生率,血气和心血管功能变化等相互比较无显著性差异（Ｐ〉０．０５）;     

两种无喉言语的比较研究

目的：比较无假体气管食管分流音与食道音在最大发声时间，可懂度和阅读时间等方面的差异，方法，研究对象包括年龄，性别和术后发声时间相当的两组无喉言语者，其中，食管音组21名，无假体气管食管音组30名，采集了两组的最大发声时间，可懂度和阅读时间的数据，用t检验分析最大发音时间和阅读时间（P＜0．05），H检验分析言语可懂度（P＜0．05），结果：食管音在这三个项目上均较气管食管分流音差；言语可懂度略差于气管食管分流音；言语流利度和最大发声时间均明显差于气管食管分流音。结论：无假体管食管音的言语效果优于食管音，而且其手术方法简单，容易训练，利于推广。     

声带小结患者显微手术前后嗓音声学分析

目的探讨声带小结患者支撑喉镜下显微手术前后嗓音声学分析指标的变化。方法采用Xion声学分析软件对45例女性声带小结患者术前1天及术后第1周、第2周、第3周进行嗓音声学分析,并与45例正常对照组对比。结果声带小结患者术前基频微扰(jitter)、振幅微扰(shimmer)均高于正常对照组,嗓音障碍指数(DSI)低于正常对照组,差异均有统计学意义(P<0.01);术后1周患者的振幅微扰及基频微扰与术前1天相比均有一定程度降低,振幅微扰与术前相比差异有统计学意义(P<0.05),但基频微扰及DSI与术前相比差异无统计学意义(P>0.05);术后2周与术前1天比较,各声学参数值差异均有统计学意义(P<0.05),且与正常对照组相比无统计学意义(P>0.05);术后3周与术后第2周相比,三项声学指标差异无统计学意义(P>0.05)。结论声带小结患者术后各阶段嗓音恢复程度不同,术后二周嗓音声学分析结果趋于正常,基频微扰、振幅微扰及DSI可以作为声带小结手术疗效评价的敏感指标。     

Effectiveness of laryngostroboscopy for monitoring the evolution of vocal nodules after rehabilitator treatment

Objective

The aim of this study is to evaluate the effectiveness of the laryngostroboscopy for monitoring the evolution of patients with vocal nodules before and after the logopedic vocal treatment.

Methods

We performed a prospective observational study of 97 dysphonic patients diagnosed of vocal nodules, where we analyzed four stroboscopic parameters (glottal closure, vocal fold vibration, mucosal wave and phase symmetry) by a protocol based on systematic subjective evaluation of the stroboscopic images before and after the rehabilitator vocal treatment; and the results were stratified according to the clinical course.

Results

All patients, before the treatment, had some abnormality in at least one of the four analyzed aspects. After the vocal treatment, we found improvement of the four parameters in different degrees. Also, we found a statistically significant relationship between the evolution of each parameter and the clinical course.

Conclusion

We believe that the laryngostroboscopy, systematized through a protocol, is a useful technique for the diagnosis of structural abnormalities in patients with vocal nodules and is a useful technique for evaluating the results after the rehabilitator treatment, as there is a statistically significant relationship between clinical course and the change in the stroboscopic findings. However it should not be the only technique used for these proposes.     

Comparison of Clonidine and Midazolam Premedication Before Endoscopic Sinus Surgery: Results of Clinical Trial

Objectives

Premedication with clonidine has been found to reduce the bleeding during endoscopic sinus surgery (ESS), therefore lowering the risk of surgical complications. Premedication is an essential part of pre-surgical care and can potentially affect magnitude of systemic stress response to a surgical procedure. The aim of this study was to compare the efficacy of premedication with clonidine and midazolam in patients undergoing sinus surgery.

Methods

Forty-four patients undergoing ESS for chronic sinusitis and polyp removal were enrolled and randomly assigned to receive either oral clonidine or midazolam as a premedication before receiving propofol/remifentanil total intravenous anesthesia. The effect of this premedication choice on anesthetic requirements, intraoperative hemodynamic profile, preoperative anxiety and sedation as well as postoperative pain and shivering were examined in each premedication group.

Results

Total intraoperative remifentanil requirement was lower in the clonidine group as compared to the midazolam group 503.2±147.0 µg vs. 784.5±283.8 µg, respectively (P<0.001). There was no difference between groups in required induction dose of propofol, level of preoperative anxiety, level of sedation and postoperative shivering. Intraoperative systemic blood pressure and heart rate response had a more favorable profile in patients premedicated with clonidine. Postoperative pain assessed by visual analogue scale for pain was lower in the clonidine group compared with to the midazolam premedication group.

Conclusion

Premedication with clonidine provides better attenuation of hemodynamic response and reduction of intraoperative remifentanil requirements in patients undergoing ESS. Postoperative pain seems to be better controlled after clonidine premedication as well.     

Long‐Term Follow‐up Results of Electrogustometry and Subjective Taste Disorder After Middle Ear Surgery

Objectives The present study compares the long‐term follow‐up results of electrogustometry with patient reports of taste dysfunction after middle ear surgery. Study Design Retrospective review of 371 patients who underwent middle ear surgery. Methods Patients were divided into the following groups depending on the degree of manipulation or surgical damage to the chorda tympani nerves: the no‐touch group (group 1 [n = 109]); the touch group (group 2 [n = 149]); and the severed nerve group (group 3 [n = 113]). Electrogustometry was periodically performed over the course of several years. Results The incidences of postoperative subjective taste disorder in groups 1, 2, and 3 were 2.8%, 25.5%, and 38.9%, respectively. Although the subjective taste disorder usually recovered within 1 to 2 years after surgery in all groups, it persisted for more than 2 years in 2.7% of the touch group and 5.3% of the severed nerve group. Concerning postoperative electrogustometric results, in the no‐touch group, 8.3% of patients showed threshold elevation on electrogustometry, but the elevated thresholds completely recovered in all cases. In the touch group, 45% of patients exhibited elevated electrogustometric thresholds on their first postoperative test, including 32.9% who subsequently had complete electrogustometric recovery, 10.1% who subsequently had incomplete recovery, and 2% who failed to recover during the follow‐up period. In the severed nerve group, none of the patients was responsive to the electrical stimulus on the first postoperative test, including 8.8% of patients who subsequently exhibited complete electrogustometric recovery, 32.7% who later had incomplete electrogustometric recovery, and 58.4% who never recovered any electrogustometric responsiveness. Nerve repair in the severed nerve group produced better recovery, as measured electrically. Conclusions The incidence of postoperative subjective taste disorder was low, although inconsistent with the high incidence of threshold elevation on electrogustometry, especially in the severed nerve group. Preservation or repair of the chorda tympani nerve is recommended in order to maintain or recover gustatory function.