支撑喉镜下硅胶膜置入治疗喉蹼

Endoscopic Silastic Keel Placement in Treatment of Laryngeal Web

目的探讨支撑喉镜下喉硅胶膜置入治疗喉蹼的效果。方法 16例喉蹼患者,1例儿童13岁,15例成人,年龄20～77岁,平均46.9±14.4岁。既往有双侧声带手术史(声带息肉、声带角化)7例,喉乳头状瘤手术史1例,喉癌手术史4例,喉部外伤史4例。表现为声嘶11例,呼吸困难5例,其中气管切开1例;16例患者均在全麻支撑喉镜下切开喉蹼后置入喉硅胶膜,2～4周后取出,随访3～24个月,平均13.1±6.7月。取出硅胶膜后1、2、3个月时行频闪喉镜检查,观察患者的发声及呼吸情况。结果 11例术前表现为声音嘶哑的患者,术后无再发粘连,发声明显改善;5例表现为呼吸困难的患者中,1例儿童患者术后一月再发粘连,再次手术后,随访3月无粘连,音质改善满意,其余4例术后无呼吸困难,音质改善,但仍有不同程度的声嘶。1例气管切开的患者术后顺利拔除气管套管。结论支撑喉镜下喉硅胶膜置入术治疗喉蹼可改善患者的发声及呼吸功能,操作简便,创伤小,并发症少。

Objective To investigate the effects of silastic keel placement for treatment of laryngeal web. Methods Sixteen patients with glottic webs were included in this study. The web causes were previous vocal fold surgery for benign lesions in 7 cases, previous laryngeal surgery for papilloma in 1 cases, laryngeal cancer in 4 ca- ses, and laryngeal trauma in 4 case. In all patients,the web were removed by scissors or carbon dioxide laser micro- surgery,and received glottic keels placement. After 2-4 weeks, the keels were removed. The above procedures were performed with laryngeal endoscopy. Results Eleven patients who performed before operation achieved good voice maintained,3 to 24 months follow-up showed without restenosis. Four patients who performed dyspnea be- fore operation showed open airway without restenosis and satisfaction with their voice improvement. One child had restenosis after one month of operation , and received revision surgery. Conclusion The study shows that silastic keel placement was successful in the treatment of laryngeal webs.