支撑喉镜下声带息肉切除术中声门显露困难患者手术方法分析

Analysis of surgical methods with difficult laryngeal exposure duriug vocal cord polypectomy under self-retaining laryngoscopy

目的探讨支撑喉镜下声带息肉切除术中声门显露困难患者的手术方法。方法选取自2013年1月至2016年12月行支撑喉镜下声带息肉切除术过程中存在声门显露困难的16例患者为研究对象,其中,通过改变支撑喉镜喉内镜放入方式,完成手术8例;结合膀胱镜完成手术5例;结合电子喉镜完成手术3例。观察并评估患者术后疗效及预后情况。结果 16例患者声门显露困难分度,Ⅲ度13例,Ⅳ度3例。患者均顺利完成手术,1例患者上切牙釉质少许磨损;2例患者口咽黏膜不同程度擦伤;1例患者术后舌体麻木。口咽黏膜损伤及舌体麻木患者均于术后1周左右恢复。术后3个月复查,3例患者声门闭合欠佳,声带边缘稍粗糙,均无息肉残留及声带损伤。随访9个月,支撑喉镜治愈7例,好转1例;结合膀胱镜治愈4例,好转1例;结合电子喉镜治愈2例,好转1例。结论支撑喉镜下声门显露困难患者可通过改变支撑喉镜喉内镜放入方式、结合膀胱镜及电子喉镜辅助完成手术。

Objective To investigate the surgical method of difficult laryngeal exposure with laryngoscope.Methods A retrospective study was performed on 16 cases of patients with difficult laryngeal exposure who were admitted from January 2013 to December 2016.Among them,8 cases were operated by changing the way of putting in laryngoscope.Cystoscope was used in 5 cases.Combined with electronic laryngoscope,3 cases were operated.The postoperative efficacy and prognosis of the patients were observed and evaluated.Results All 16 patients glottis appeared difficult degree,Ⅲ degrees in 13 cases and Ⅳ degrees in 3 cases.All patients were performed surgery successfully.The enamel of the upper incisor of 1 patient was slightly worn.Abrade of oropharyngeal mucosa in 2 cases;1 patient had postoperative tongue numbness.Patients with oropharyngeal mucosal injury and tongue numbness recovered about 1 week after surgery.Three months after surgery,3 patients showed poor glottis closure,slightly rough vocal cord edges,no residual polyps and vocal cord injury.During the follow-up of 9 months,7 cases were cured and 1 was improved by self-retaining laryngoscope;4 cases were cured and 1 was improved by cystoscope.Combined with electronic laryngoscope,2 cases were cured and 1 case was improved.Conclusion Patients with difficult laryngeal exposure under the self-retaining laryngoscope can complete the surgery by changing the placement of the self-retaining laryngoscope and combining cystoscope and electronic laryngoscope.