内镜下微创外科技术在声带疾病的临床应用

目的探讨经内镜支撑喉镜下微创外科技术在声带疾病的临床应用效果。方法 2005年1月～2008年1月,对小声带息肉及声带小结58例,广基底息肉30例,任克层水肿25例,声带囊肿36例,声带白斑11例共160例声带疾病患者采用内镜下微创外科治疗,采用显微切除技术58例、外侧微瓣技术67例、内侧微瓣技术24例、黏膜下注射技术及黏膜表皮剥脱技术11例。结果声带小结26例及声带息肉62例均一次切除病变。声带囊肿病变有2例(2/36,5.6%)术后发生黏膜瓣下端断裂漂移,后在电子喉镜下切除断裂黏膜瓣;另34例一次切除病变。任克层水肿25例全部消除声带浅固有层下水肿。150例(94%)术后1周经嗓音分析检查恢复正常嗓音,另10例在术后2周～3个月恢复正常嗓音。声带白斑11例全部随访1～3年,平均1.6年,术后2个月经电子喉镜检查均未见病变复发,病理报告为不典型增生的7例中有2例术后1年复发。结论内镜引导支撑喉镜下微创外科技术治疗声带疾病符合微创原则,近期疗效良好。

Endoscopic Minimally Invasive Surgery for Vocal Cord Diseases

Objective To observe the clinical value of self-retaining laryngoscope in the treatment of vocal cord diseases.Methods From January 2005 to January 2008,160 patients with vocal cord diseases,including 58 patients with small vocal cord polyps and vocal nodule,30 patients with broad basis polyps,25 cases of Reinke＇s edema,36 cases of vocal cord cyst,and 11 patients with vocal cord floccosoids,received minimally invasive surgery in our hospital by using self-retaining laryngoscopy.In the cases,micro-excision technology was used in 58 cases,lateral microflap technique was employed in 67 cases,and medial microflap technique in 24 cases;submucosal injection and decortication were performed in 11 patients.Results Of the cases,26 patients with vocal nodule and 62 patients with vocal cord polyp were cured by one operation.In the 36 patients with vocal cord cyst,one-operation success was achieved in 34 of them,the other two（2/36,5.6%）received a second operation because the mucosal flap was broken and moved.All of the 25 patients with Reinke＇s edema were cured.One week after the treatment,150 patients（94%）recovered normal voice,and the other 10 recovered in 2 to 3 weeks.The 11 patients with vocal cord floccosoids were followed up for 1 to 3 years（mean,1.6 years）,no recurrence was detected by electronic laryngoscopy in the first 2 months,however,in 2 of the 7 cases who had atypical proliferation showed recurrent lesions in one year.Conclusion Self-retaining laryngoscopy is minimally invasive and effective for vocal cord diseases.