鼻内镜下联合自制角度喉钳切除声门暴露困难声带息肉23例

doi:10.6040/j.issn.1673-3770.0.2018.426

摘要/Abstract

摘要： 目的

探讨鼻内镜下联合自制角度喉钳切除声门暴露困难声带息肉的效果。

方法

对23例声带息肉手术中遇到声门暴露困难患者，支撑喉镜常规插管后鼻内镜下在成像系统看清病变部位，取合适的喉钳，将喉钳头端1~2 cm处制成所需的弯度，将处置过喉钳伸入喉镜至声带息肉处常规咬除息肉，修齐声带边缘。术后常规静脉滴注抗生素3 d，并雾化吸入布地奈德气雾剂,2次/d，连续3 ｄ。嘱声休2周，多做深吸气动作，禁烟酒。

结果

23例患者均一次完全切除声带息肉，手术时间平均10 min，均无颈椎损伤、舌体损伤、牙齿脱落等严重并发症发生。23例术后均获随访3～12个月，平均6个月，患者对术后声音恢复情况满意，无明显的声音嘶哑，复查喉镜检查见声带边缘光滑，无黏连、缺损，随访期间无息肉复发。

结论

鼻内镜下联合自制角度喉钳切除声门暴露困难的声带息肉疗效确切。

关键词: 声带息肉, 鼻内镜, 支撑喉镜, 喉钳

Abstract: Objective

To investigate the outcomes of endoscopic removal of vocal cord polyps with angled-laryngeal forceps.

Methods

Nasal endoscopy was performed after conventional intubation with a support laryngoscope, to identify lesions on an imaging system in 23 patients with difficulty in glottis exposure during vocal cord polyp surgery. Appropriate laryngeal forceps were chosen and bent to the required degree, 1-2 cm from the end. They were were then extended into the laryngoscope until reaching the vocal cord polyps. The polyps were then routinely excised, and the edge of the acoustic band was subsequently repaired. Postoperative management included routine intravenous infusion of antibiotics for 3 days and inhalation of budesonide aerosol twice daily for 3 days. The patients were advised 2 weeks of rest, deep breathing, and abstinence from smoking and alcohol.

Results

In all 23 patients, the vocal polyps were excised in the first attempt, with an average operative time of 10 min, and no serious complications, such as cervical spine injury, tongue injury, or tooth loss. All 23 patients were followed up for 3-12 months (average, 6 months) postoperatively. The postoperative course was uneventful and there was no obvious voice hoarseness. Re-examination using a laryngoscope showed smooth edges of the vocal cords, without adhesion and defects, and no polyp recurrence during the follow-up period.

Conclusion

Treatment of vocal polyps with difficult exposure of the glottis is possible with nasal endoscopy and angled-laryngeal forceps.

Key words: Vocal cord polyp, Nasal endoscope, Laryngoscope, Laryngeal forceps

中图分类号:

R767.4

鞠丽娴,李井成,夏克玉,董伟达. 鼻内镜下联合自制角度喉钳切除声门暴露困难声带息肉23例[J]. 山东大学耳鼻喉眼学报, 2019, 33(3): 116-118.

Lixian JU,Jingcheng LI,Keyu XIA,Weida DONG. Vocal polyps treated with nasal endoscopy and angled-laryngeal forceps: report of 23 cases[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(3): 116-118.

图/表 1

图1

参考文献 8

1	郝艳,李栋才,蓝建平.CO ₂ 激光显微手术与传统显微手术切除声带息肉疗效比较[J].山东大学耳鼻喉眼学报，2017,31（6）：68-70.doi：10.6040/j.issn.1673-3770.0.2017. 034. doi: 10.6040/j.issn.1673-3770.0.2017.034
	HAOYan, LIDongcai, LANJianping. Comparison of the curative effect of CO₂ laser microsurgery and conventional microsurgery for vocal polyp resection[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2017, 31(6): 68-70.doi：10.6040/j.issn.1673-3770.0.2017.034 doi: 10.6040/j.issn.1673-3770.0.2017.034
2	李敏雄，陈观贵，何清泉.鼻内镜联合支撑喉镜下电动切削器切除声带息肉[J].中国耳鼻咽喉颅底外科杂志，2006,12（1）：43.doi:10.3969/j.issn.1007-1520.2006.01. 011. doi: 10.3969/j.issn.1007-1520.2006.01.011
	LIMinxiong,CHENGuangui,HEQingquan.The vocal polyps were excised by an electric cutter under a nasal endoscopy combined with a supporting laryngoscope[J]. Chinese Journal of Otorhinolaryngology-skull Base Surgery, 2006, 12（1）：43.doi:10.3969/j.issn.1007-1520.2006.01.011. doi: 10.3969/j.issn.1007-1520.2006.01.011
3	赵亮，谢洪，周晓红，等.鼻内镜联合支撑喉镜切除声门暴露困难的声带息肉[J].中国微创外科杂志，2012,12（4）：354.doi:10.3969/j.issn.1009-6604.2012.04.020. doi: 10.3969/j.issn.1009-6604.2012.04.020
4	梁根田，王素芳，孙广滨,等.电子喉镜与支撑喉镜下手术治疗广基声带息肉疗效分析[J].中国中西医结合耳鼻咽喉科杂志，2007,15（1）:65-66.
5	任庆,王景和.鼻内镜引导下支撑喉镜治疗声带息肉研究(附114例)[J].山东大学耳鼻喉眼学报,2011,25(4):69-70.
	RENQing，WANGJinghe. Study on the treatment of vocal cord polyp by supporting laryngoscope under nasal endoscope[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2011, 25（4）:69-70.
6	怀德,张亚龙,周晓健,等.支撑喉镜下声门暴露困难患者声带病变的处理[J].中国耳鼻咽喉头颈外科,2011,18(11):623-624.
7	陶冶.鼻内镜下应用支气管镜活检钳切除声门暴露极困难的声带息肉[J].听力学及言语疾病杂志，2016,24（3）:311-312. doi:10.3969/j.issn.1006-7299.2016.03.024. doi: 10.3969/j.issn.1006-7299.2016.03.024
	TAOYe. Endoscopic bronchoscopic biopsy forceps were used to remove vocal polyps with extremely difficult exposure to glottis under nasal endoscopy[J].Journal of Audiology and Speech Pathology, 2016,24(3):311-312.doi:10.3969/j.issn.1006-7299.2016.03.024. doi: 10.3969/j.issn.1006-7299.2016.03.024
8	陈文勇,任光第,梁艳.不同手术方式对声带息肉术后嗓音功能的影响[J].广东医学，2013,32（8）:1022-1023.doi:10.3969/j.issn.1001-9448.2011.08.027. doi: 10.3969/j.issn.1001-9448. 2011. 08. 027
	CHENWenyong,RENGuangdi,LIANGYan.Effects of different surgical methods on voice function after vocal cord polyp[J].Guangdong Medical Journal， 2013，32（8）：1022-1023.doi:10.3969/j.issn.1001-9448. 2011. 08. 027. doi: 10.3969/j.issn.1001-9448. 2011. 08. 027

相关文章 15

[1]	赵艳,程四华,童巧珍. 强化自我护理对喉镜辅助声带息肉切除术后患者嗓音恢复及心理情绪的影响[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 175-178.
[2]	邱前辉,陈卓. 鼻内镜手术治疗首诊局部晚期鼻咽癌及放疗后严重并发症的作用[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 17-20.
[3]	刘全,孙希才,于华鹏,赵可庆,张焕康,赵卫东,顾瑜蓉,李厚勇,王德辉,余洪猛. 鼻内镜下鼻咽癌切除术的手术分型[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 39-45.
[4]	赵丽娟,姜彦,于龙刚,蔡亮,陈敏,张继生,李志远,鞠建宝,李娜. 鼻咽癌内镜手术治疗临床分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 51-56.
[5]	余洪猛,刘琢扶,戴琪. 合并哮喘的慢性鼻-鼻窦炎的鼻内镜手术治疗[J]. 山东大学耳鼻喉眼学报, 2019, 33(1): 38-41.
[6]	齐岩,刘俊其,彭舒娅,罗凯,张名霞,王振霖. 鼻内镜下选择性翼管神经切断术对伴有变应性鼻炎的慢性鼻窦炎的疗效观察[J]. 山东大学耳鼻喉眼学报, 2019, 33(1): 109-113.
[7]	张伟,刘勇刚,江玲燕. 功能性鼻内窥镜术后慢性鼻窦炎患者短期布地奈德盐水盥洗疗效观察[J]. 山东大学耳鼻喉眼学报, 2019, 33(1): 128-130.
[8]	宋晓宇, 张宇, 李成林, 宋西成. 加速康复外科理念在慢性鼻-鼻窦炎伴鼻息肉手术治疗中的应用[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 9-12.
[9]	沈勤峰,沈小燕,朱荣强,蒋斐斐,郎军添. 鼻内镜下中鼻甲功能性部分切除治疗慢性鼻窦炎76例分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 82-85.
[10]	许雯,汤玮,余少卿,李少辉,葛荣明. 平阳霉素治疗咽喉部血管瘤[J]. 山东大学耳鼻喉眼学报, 2018, 32(4): 62-64.
[11]	李华斌, 赖玉婷. 慢性鼻-鼻窦炎的发病机制及诊疗进展[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 4-9.
[12]	张炜,曾昱菡,余先崧. 慢性鼻窦炎手术前后ECP、EGF、IL-6的水平变化及临床意义[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 63-67.
[13]	刘婷婷,王学海,蔡晓岚,田泽静,张立强,李学忠. 鼻内镜下口-鼻联合入路切除鼻底累及硬腭巨大肿瘤两例[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 108-110.
[14]	王愿,周涵,刘晓静,张立庆,赵青,冯剑,董伟达. 鼻内翻性乳头状瘤的术式选择和疗效分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 79-83.
[15]	胡道彩,仲军文,杨旭东. 鼻内镜术后伴发严重血小板减少一例报告[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 113-114.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed