颈部疤痕手术气管插管后环杓关节脱位病例报告与相关病例分析

Arytenoid dislocation in patients with postburn jugular scar after tracheal intubation for anaesthesia and analysis of related reports

目的总结与探讨颈部烧伤后疤痕手术患者气管插管麻醉所致环杓关节脱位的发病原因,临床表现与发病机制,诊断,处理和预防。方法总结5例缘于颈部烧伤后疤痕挛缩畸形患者的临床资料,在经过气管插管全麻操作后患者出现声嘶、咽痛、发声困难、失声等症状。间接喉镜检查提示环杓关节脱位。治疗采用1%的盐酸丁卡因行咽喉部黏膜表面麻醉,直接喉镜或间接喉镜下行环杓关节拔动术,发声好转为复位成功的标志。结果5例中一次治愈4例,声嘶、气短、憋气等症状消失,杓状软骨及声带活动正常,声带闭合好。1例因喉部对外来刺激极敏感,行2次环杓关节拔动术后放弃,声嘶无明显好转,气短好转,患侧声带固定,2周后声嘶改善。结论颈部困难气管插管过程中应当防止出现环杓关节脱位,喉镜下行环杓关节拨动术有助于治疗。

Objective To explore the etiology, pathogenesis, clinical features, diagnosis, management and prevention of arytenoid dislocation caused by tracheal intubation during anaesthesia in patients with postburn jugular hypertrophic scar. Methods Clinical data were collected from 5 cases ofpostburn jugular hypertrophic scar with deformity. Tracheal intubation was performed during the surgery with post-operative signs of hoarseness, sore throat, dysphonia and apbonia. It was indicated by indirect laryngoscope that there was arytenoid dislocation. As for the treatment, the gular mucosal surface was sprayed by 1% tetracaine solution for anaethesia. Arytenoid articulation moving was performed under direct or indirect laryngoscope. Improvement of the pronunciation was considered successful correction. Results Four cases out of 5 were corrected by one time manipulation. The patients＇ symptoms of hoarseness, short breath and suffocation feeling disappeared with the restoration of normal movement of arytenoids and vocal fold. The vocal fold closed well. The operation failed in one case due to patient＇s allergy to any stimulation on the throat. There was improvement of short-breath signs by two times of manipulation. The patient＇s symptom of hoarseness improved automatically 2 weeks later and the ill-side vocal fold closed well. Conclusions Arytenoid joint dislocation should be noticed and prevented during difficult tracheal intubation. Arytenoid joint moving operation under laryngoscope was helpful to solve the problem.