3种不同方法取咽部异物的临床效果

Clinical Effect of Three Different Methods to Extract Foreign Bodies from Pharynx

目的 探讨使用间接喉镜、硬性喉镜及电子纤维喉镜3种方法在咽部异物取出术的优先选择。方法 回顾性分析2018年1月至2022年3月就诊于我科的360例咽部异物患者的病历资料,均明确诊断为咽部异物,其中间接喉镜组、硬性喉镜组、电子纤维喉镜组各120例,均在表面麻醉下取咽部异物。结果 在术前准备耗时方面间接喉镜组耗时最少,电子纤维喉镜组耗时最长;手术耗时方面电子纤维喉镜组耗时最少,间接喉镜组耗时最长;术后症状完全消失时间方面,电子纤维喉镜组最短,间接喉镜组最长;费用方面间接喉镜组最少,电子纤维喉镜组最多;一次性成功取出率,电子纤维喉镜组最高,间接喉镜组最低;术中黏膜损伤发生率方面,电子纤维喉镜组最低,间接喉镜组最高;术中更改手术方式方面,电子纤维喉镜组最低,间接喉镜组最高;总手术成功率方面,Ⅲ级咽反射患者,3组间差异无统计学意义(P> 0.05);Ⅰ、Ⅱ级咽反射患者,电子纤维喉镜组、硬性喉镜组优于间接喉镜组,电子纤维喉镜组、硬性喉镜组间差异无统计学意义(P> 0.05)。结论 对于Ⅲ级咽反射及较大异物的Ⅱ级咽反射的患者优先采用间接喉镜法取咽部异物,简便快捷,费用低廉;对于Ⅱ级咽反射且较大异物及Ⅰ级咽反射的患者优先采用硬性喉镜法取咽部异物;对于细小异物、颈部粗短、舌根肥厚的Ⅰ级咽反射的患者优先采用电子纤维喉镜法取咽部异物。

Objective To explore the preference of indirect laryngoscope,rigid laryngoscope and electronic fiber laryngoscope for foreign body removal from pharynx.Methods The data of 360 cases of foreign body in pharynx treated in our department from January 2018 to March 2022 were retrospectively analyzed.All cases were diagnosed as foreign body in pharynx,including 120 cases in indirect laryngoscope group,120 cases in rigid laryngoscope group and 120 cases in electronic fiber laryngoscope group.All cases were removed under surface anesthesia.Results The indirect laryngoscopy group took the least time and the electronic fiber laryngoscopy group the longest time in preoperative preparation.In terms of operation time,the electronic fiber laryngoscopy group took the least time and the indirect laryngoscopy group took the longest time.The time of complete disappearance of postoperative symptoms was the shortest in the electronic fiber laryngoscopy group and the longest in the indirect laryngoscopy group.The indirect laryngoscopy group was the least and the electronic fiber laryngoscopy group was the most.The one-time successful extraction rate was the highest in the electronic fiber laryngoscopy group and the lowest in the indirect laryngoscopy group.In terms of intraoperative mucosal injury,the electronic fiber laryngoscopy group had the lowest and the indirect laryngoscopy group had the highest.The changes of surgical methods during operation were lowest in the electronic fiber laryngoscopy group and most in the indirect laryngoscopy group.There was no significant difference in the total success rate of patients with gradeⅢpharyngeal reflex(P>0.05).There was no significant difference in the total success rate of patients with gradeⅢpharyngeal reflex.In patients with gradeⅠandⅡpharyngeal reflex,the electronic fiber laryngoscopy group and the rigid laryngoscopy group were better than the indirect laryngoscopy group,and there was no statistical difference between the electronic fiber laryngoscopy group and the rigid laryngoscopy group(P>0.05).Conclusion Indirect laryngoscopy is preferred for patients with gradeⅢpharyngeal reflex and gradeⅡpharyngeal reflex with large foreign bodies.For gradeⅡand gradeⅠpatients with large foreign bodies,rigid laryngoscopy is preferred for the extraction of pharyngeal foreign bodies.For patients with gradeⅠpharyngeal reflex with small foreign bodies,thick neck and thick tongue root,electronic fiber laryngoscopy is preferred for the removal of pharyngeal foreign bodies.