支撑喉内镜下喉部良性肿物切除术致咽部损伤原因分析及处理

Analysis and Treatment of the Causes of Pharyngeal Injury Caused by Laryngeal Benign Tumor Resection Under the Support Laryngoscope

目的分析支撑喉内镜下喉部良性肿物切除术致咽部损伤原因及处理办法。方法对65例支撑喉内镜下喉部良性肿物切除术致咽部损伤患者病种、病变在喉部位置、条件归类分析,损伤后处理总结。结果损伤部位均位于腭舌弓中下部,腭舌弓与舌根交汇处,其中黏膜下轻微挤压损伤35例,黏膜及黏膜下撕裂30例,伤口渗血7例,伤口出血23例。Friedman分级中Ⅲ级、Ⅳ级患者损伤重;喉腔外病变者咽部损伤多数为黏膜下轻微挤压损伤,喉腔病变者咽部损伤较重,特别是病变在声带前半部者。所有患者经及时、正规处理,无二次重返手术室手术的,亦无近远期严重并发症发生。结论支撑喉内镜下喉部良性肿物切除术致咽部损伤主要与患者本身解剖结构畸形有关,其次与病变在喉部部位(支撑喉镜插入深度)、手术者操作手法有关,对不可避免的副损伤及时、正确处理,谨防严重并发症发生。

Objective To analyze the causes and treatment of pharyngeal injury caused by laryngectomy with laryngoscope.Methods Sixty five patients with pharyngeal injury caused by laryngeal benign tumor resection under laryngoscope were analyzed in terms of disease type,location,condition and post-traumatic treatment.Results All the lesions were located in the middle and lower part of the palatoglossal arch and the junction of the palatoglossal arch and the tongue root,including 35 cases of slight submucous crush injury,30 cases of submucous tear,7 cases of bleeding and 23 cases of bleeding.Grade III and IV patients were accompanied with different degrees of dentition irregularity,micrognathia deformity or short body fat neck;most of the pharyngeal injuries in patients with epiglottis lesions were slight submucous crush injuries,and those with vocal cord lesions were more severe,especially in the anterior part of the vocal cord.After timely and regular treatment,none of the patients returned to the operating room for a second time,and no serious complications occurred in the near and long term.Conclusion The injury of pharynx caused by resection of benign tumor of larynx under laryngoscope is mainly related to the deformity of the patient's own anatomical structure,and secondly related to the lesion in the larynx(insertion depth of laryngoscope)and the operator's manipulation.The inevitable side injury should be handled correctly and serious complications should be prevented.