支撑喉镜下CO_2激光分离联合硅胶膜置入治疗继发性声带粘连

Use of Suspension Laryngoscopy CO_2 Laser Combined with Placement of Silastic Keel for the Treatment of the Vocal Cords Adhesion

目的探讨支撑喉镜下应用CO_2激光分离切除声带蹼样粘连后置入硅胶膜治疗继发性声带粘连的临床疗效。方法以21例继发性声带粘连的成年患者为研究对象,其中,发生于双侧声带任克水肿、声带小结、声带息肉、声带白斑手术后16例,喉乳头状瘤手术后4例,喉部外伤导致声带粘连1例,粘连范围均为声带前1/3~1/2;均在支撑喉镜下应用CO_2激光分离并切除声带前部正中粘连带后,置入的硅胶膜使其隔离声门前端分离的创面并经喉内、外联合进路缝合固定于颈前皮肤;术后3周取出硅胶膜,随访半年,观察疗效。结果 20例患者术后3周顺利取出硅胶膜,1例患者术后2周因颈部软组织感染取出硅胶膜后痊愈;术后随访6个月,除1例患者再次发生声带前联合粘连外,其余20例患者声带前联合均获得良好三角形形态,无瘢痕及肉芽形成,声嘶均明显改善。结论支撑喉镜下CO_2激光分离联合硅胶膜置入隔离创面3周治疗声带粘连,创伤小,效果好,并发症少。

Objective To investigate the use of suspension laryngoscopy CO_2 laser combined with the placement of laryngeal stent for the treatment of the vocal cords adhesion.Methods A total of 21 patients with acquired vocal cords of adhesion patients(The causes were previous vocal fold surgery for benign lesions in 16 cases,the laryngeal surgery for recurrent papilloma in 4 cases,the laryngeal trauma in 1 case)were included in this retrospective study.Under general anesthesia with intubation,following glottis exposure under suspension laryngoscopy,a CO_2 laser incision was performed under microscopy on the superior face of one vocal fold,from the anterior commissure to the posterior part of the web.The keel was placed into the larynx to the appropriate location and fixed with sutures.Results The keels were removed after 3 weeks of operation in 20 patients.The keels were removed after 2 weeks of operation because of subcutaneous emphysema in 1 patient.After a follow-up of 6 months,the reformation of the web happened in 1 case,while the remaining 20 patients recovered with normal triangle shaped anterior commissure anatomy and no granulation or scar tissue were formed.Conclusion Our study shows that the use of suspension laryngoscopy CO_2 laser combined with the placement of laryngeal stent is successful for the treatment of the vocal cords adhesion.This procedure has the advantages of micro trauma to patients with avoiding laryngofissure,it provides simple effective treatment of vocal cords adhesion.