青少年型复发性呼吸道乳头状瘤吸割切除的麻醉方式选择

Anesthesia Means Choice of Laryngeal Microdebrider Removal of Juvenile,onset Recurrent Respiratory Papillomas

【目的】探讨内窥镜辅助支撑喉镜下应用喉吸切钻切除青少年型复发性呼吸道乳头状瘤(JO-RRP)的麻醉方式的选择。【方法】配对比较20例JO-RRP患儿分别在静脉复合麻醉高频通气辅助呼吸和气管内插管全麻下应用内窥镜辅助支撑喉镜下喉吸切钻切除肿物;肿物的严重程度分为三级(轻1分,中2分,重3分),评价患儿27个呼吸和消化道的解剖亚区,计算总积分并按积分分两组,比较两组同积分病例的手术时间、术后声音质量和麻醉苏醒时间变化。【结果】20例患儿进行了40次手术,相同积分的病例中,高频通气辅助呼吸或气管插管全麻下应用喉吸切钻切除JO-RRP的麻醉苏醒时间、手术时间和术后声音质量均无显著差异。前者有6例出现憋气、喉痉挛等现象,后者无1例出现。【结论】内窥镜辅助支撑喉镜下应用喉吸切钻处理JO-RRP,选择静脉复合麻高频通气辅助呼吸或气管内插管全麻均能顺利完成手术,但后者麻醉风险较少。

[Objective] To investigate the choice of anesthesia means of laryngeal microdebrider removal of juvenile-onset recurrent respiratory papillomas （JO-RRP）. [Methods] Twenty cases of JO-RRP patients were removed papillomas by microdebrider under high frequent jet ventilation assistant general anesthesia and intratracheal intubation anesthesia respectively. Severity of disease was scored as the sum of ratings of 1 （minimal）, 2 （moderate）, or 3 （severe） for involvement of 27 areas of the aerodigestive tract, a Storz laryngoscope was used to expose and suspend the larynx, and an endoscope video system was used to display the pathological changes. The voice quality of postoperative patients, procedure time, and anesthesia time were compared. [Result] Twenty cases underwent 40 procedure. For disease of equivalent severity, two means of anesthesia were associated with similar result in voice quality, procedure time, and anesthesia time. Six cases felt suffocating or laryngeal spasm in former means. [Conclusion] We concluded that the choice of both high frequent jet ventilation assistant general anesthesia and intratracheal intubation anesthesia could be successful in removal of papillomas performed by microdebrider. And the latter was safer and more convenient.