喉显微激光术后声带粘连的治疗和预防

Treatment and prevention of vocal cord adhesion after microlaryngosurgery

目的探讨内镜下喉内置入非聚氯乙烯(polyvinyl chloride,PVC)喉膜治疗和预防双侧声带粘连的临床疗效。方法收集2013年1月~2017年9月在我科行CO2激光喉显微手术后喉腔置入非PVC喉膜治疗和预防声带粘连的25例患者临床资料,其中16例(治疗组)双侧声带病变术后4~13个月声带粘连患者(严重程度为II~Ⅳ级,均未累及声门下),行CO2激光分离粘连后喉外法喉膜置入;9例(预防组)前连合病变和累及前连合的双侧声带病变患者,行CO2激光切除病变,术中喉外法同期行喉膜置入预防术后声带粘连或喉狭窄。上述25例患者术前术后均行主观嗓音质量评估。术后4周左右取出喉膜,至少随访12个月,观察术后声门形态及临床疗效。结果治疗组16例患者中,有效13例(81.25%),无效3例(18.75%)。预防组9例一期喉膜置入预防声带粘连患者中,有效6例(66.67%),无效3例(33.33%)。治疗组术后嗓音障碍指数较术前明显改善(P<0.01),两组术后均无明显并发症。结论内镜下喉外法喉内植入非PVC喉膜是治疗和预防声带粘连的有效方法,值得推广应用。

OBJECTIVE To explore the clinical effect of endoscopic implantation of non-polyvinyl chloride(PVC)laryngeal membrane in the treatment and prevention of bilateral vocal cord adhesion.METHODSClinical data of 25 patients with non-PVC keel implantation for the treatment and prevention of vocal cord adhesion after CO2 laser laryngeal microsurgery in the Department of Otolaryngology,Second Affiliated Hospital of Zhejiang University Medical College,from January 2013 to September 2017 were collected.Among them,16 patients(treatment group)had bilateral vocal cord lesions with vocal cord adhesions 4 to 13 months after the operation,and the keel was implanted after CO2 laser separated the adhesion.Nine patients(prevention group)with anterior commissure and bilateral vocal cord lesions involved anterior commissure were treated with CO2 laser to remove the lesions.The keel was performed concurrently under the endoscope during the operation to prevent vocal cord adhesion or laryngeal stenosis after surgery.The above 25 patients underwent subjective voice quality assessment before and after surgery.The keel was removed about 4 weeks post-surgery to observe the glottic morphology and clinical efficacy.RESULTS During at least 12 months of follow-up,of the 16 patients in the treatment group,13 were effective(81.25%)and 3 were ineffective.Of the 9 patients in the prevention group with primary keel implantation to prevent vocal cord adhesion,6(66.67%)were effective and 3 were ineffective.The postoperative voice handicap index in the treatment group was significantly improved compared with that before operation(P<0.01),and there were no obvious complications after operation.CONCLUSIONEndoscopic non-PVC keel placement is aneffective method for the treatment and prevention of vocal cord adhesion.It is worthy of popularization and application.