高渗葡萄糖联合胰岛素局部换药治疗咽瘘的临床研究

目的观察高渗葡萄糖联合胰岛素局部换药治疗咽瘘的临床效果,探讨咽瘘的治疗经验。方法回顾性分析12例全喉切除术后并发咽瘘者应用高渗葡萄糖联合胰岛素治疗的临床资料。12例均于常规清创处理后,以50％葡萄糖注射液10～20ml加精蛋白锌胰岛素10～20U的混合液擦洗伤口2或3次,再使用混合液纱条填寒瘘腔,外覆无菌干纱布,最后对咽瘘周围组织适度加压包扎,并观察创面愈合情况和时间。结果12例创面全部达到痊愈标准,平均痊愈时间19．6d;观察6个月,无一例出现吞咽困难。结论高渗葡萄糖联合胰岛素可通过控制创面感染、清除坏死组织、促进肉芽组织和上皮细胞生长等促进全喉切除术后咽瘘创面愈合,方法简单,值得推广应用。

A Clinical Research of Hyperosmotic Glucose Combined with Insulin by the Local Dressing Change in Treating Pharyngeal Fistula

Objective To observe the clinical efficacy of hyperosmotic glucose combined with insulin and the local dressings change in treating pharyngeal fistula and explore therapeutic experience.Methods Retrospective analysis of clinical data of hyperosmotic glucose combined with insulin in treating 12 patients with pharyngeal fistula after total laryngectomy were performed.The 12 patients were treated with routine debriding,and then cleaned with 10-20 ml zinc-protamine insulin,50% glucose injection combined with 10-20 U for 2 or 3 times,soaked and filled the fistula with mixture gauze,covered with dry sterile gauze and pressured dressing of surrounding tissues.Healing circumstance and healing time of the wound were observed.Results The wounds of 12 patients with pharyngeal fistula all fully recovered.The average healing time was 19.6 days.No dysphagy was observed during the continual observation for 6 months.Conclusion Hyperosmotic glucose combined with insulin can promote the pharyngeal fistula healing after total laryngectomy by controlling the fistulae infection,dissolving the necrotic tissues,promoting the growth of granulation tissues and epithelial cells.