可调式支撑喉镜下声门暴露困难患者的喉显微外科手术

目的：探讨支撑喉镜下声门暴露困难患者喉显微外科手术安全有效的方法。方法2012年7月～2015年6月65例术前评估为声门暴露困难的成年患者中有62例（95．38％）在经支撑喉镜行喉显微外科手术中发生声门暴露困难，其中，声带息肉42例，声带囊肿9例，声带淀粉术变5例，声带重度不典型增生4例，声带高分化鳞癌2例；回顾性分析这62例患者的临床资料，对完成喉显微外科手术的方法进行分析。结果62例患者术中使用普通支撑喉镜均声门暴露困难，58例（93．55％，58／62）改用可调式电视支撑喉镜顺利完成手术，其中，10例加深麻醉深度配合30°内镜并按压喉体使声门暴露完全完成手术，但有5例患者术后出现不同程度的咽后壁损伤；1例伴小颌畸形的声带广基息肉患者手术未成功，改为表面麻醉电子喉镜下完成手术；1例牙列不齐并装有烤瓷牙的患者及2例声带癌患者改行无气管切开喉裂开术。结论支撑喉镜下声门暴露困难者大部分可通过带内镜的可调式电视支撑喉镜安全有效地暴露声门，部分患者可同时经支撑喉镜侧通道放入30°内镜辅助暴露声门，以完成各类喉显微外科手术。

Use of Self-retaining Laryngoscope in Difficult Laryngealy Exposure in Laryngeal Microsurgery

Objective To investigate the safe and effective method for laryngeal microsurgery in difficult la‐ryngeal exposure cases .Methods We selected 62 patients’ clinical data who had received laryngeal microsurgery with difficult laryngeal exposure and could not exposure by normal self -retaining laryngoscope between July 2012 and June 2015 .There were 42 cases of vocal cord polyp ,9 cases of the vocal cyst ,5 cases of the vocal amyloidosis , 4 cases of severe atypical hyperplasia of vocal cords and 2 cases of vocal cord high differentiated squamous carcino‐ma .We completed all kinds of laryngeal microsurgery to expose the glottis by adjusting the postures of patients ,in‐creasing the anesthesia depth ,using self -retaining laryngoscope with endoscopy which can be adjusted and pressing the throat .Results In 62 patients ,58 patients were successfully operated with adjustable self -retaining laryngo‐scope with endoscopy ,the success rate was 93 .55% .And 25 cases was exposed the glottis completely by increasing the anesthesia depth ,however ,when we increased the anesthesia depth ,there were 10 cases needed to combined with pressing the throat to expose .Five patients had retropharyngeal injure with different levels .One case with small jaw deformity of the vocal cord polyp surgery was not successful ,the success of electronic endoscopic under surface anesthesia surgery .The other one case with teeth unkempt and porcelain teeth and two cases of intraoperative frozen tip vocal cord cancer completed the operation of the open throat under the non trachea incision .Conclusion Most of difficult exposed laryngeal can be safely and effectively exposed through using the adjustable self -retaining laryngo‐scope with endoscopy while normal self -retaining laryngoscope can not .When necessary ,we can put 30°endoscope into the side channel of self -retaining laryngoscope to complete all kinds of laryngeal microsurgery .