防止喉部前连合手术后粘连的动物实验研究  

Preventing laryngeal anterior commissure adhesion after operation:a study in canines

作　　者：钱丽芳[1] 方勤[2] 胥伟华[2] 孙娜[2] 陈群[2] 董兴睿 李帏帏 孙广滨[2] 

机构地区：[1]宁夏医科大学耳鼻咽喉科,银川750004 [2]上海市浦东新区公利医院耳鼻咽喉科

出　　处：《临床耳鼻咽喉头颈外科杂志》2011年第12期557-559,共3页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：上海市自然科学基金资助课题(No:10ZR1427200);上海市浦东新区科委资助课题(No:PKL2008-Y29)

摘　　要：目的:探讨激光手术治疗喉部前连合疾病时,既可以切除病变,又可以避免术后粘连、喉狭窄及呼吸困难的较理想手术方法。方法:将12只实验犬随机分成A、B、C、D 4组,每组3只。A组分2次手术切除实验犬前连合,间隔时间为2周;B组一次性切除前连合,同时以硅胶膜片缝合固定于前连合处,2周后拆除硅胶膜;C组一次性切除前连合,术后前连合创面涂丝裂霉素-C;D组一次性切除前连合,术后创面不做其他处理。结果:全部实验犬均在激光下顺利按计划完成手术,术后4周创面观察:A组创面有新生黏膜覆盖,炎症反应轻,前连合无明显粘连;B组创面黏膜覆盖,局部见暗红色慢性炎症改变,前连合轻度粘连;C组创面黏膜覆盖,术区水肿,前连合中度粘连;D组术区肿胀,前连合明显粘连。A、B、C、D 4组犬吠均有不同程度的声嘶,A组最轻,B、C组次之,D组最重。4组实验犬声带长度资料分析:A、B、C组声带长度术后较术前缩短不明显(P>0.05),D组声带长度术后较术前明显缩短(P<0.01);不同处理组间声带长度变化有差异,经两两比较,A组效果最好,B、C组次之,两者之间无明显差异。4组实验犬声门面积资料分析:A、B 2组声门面积术前术后变化不明显(P>0.05),C、D 2组声门面积术后较术前明显缩小(P<0.05);组间比较采用重复测量方差分析(P>0.05),尚不能认为4组之间声门面积变化有明显差异。结论:激光手术切除实验犬前连合,A组防止术后粘连效果最好,B、C组次之。本实验结果对临床中应用激光治疗侵犯至前连合病变的术式选择有一定的参考价值。Objective：To explore the better operational methods by the laser surgery to treat diseases involving the laryngeal anterior commissure.It can excise the diseases as well as avoid anterior commissure adhesion,laryngostenosis and dyspnea after operations.Method：Twelve dogs were divided into 4 groups at random.There were three dogs in one group.A： excising experimental dog′s anterior cimmissure by twice operations,the interval time was two weeks;B： excising experimental dog′s anterior cimmissure in one time,at the same time suturing the silica gel sheet on the anterior commissure;C： excising experimenal dog′s anterior cimmissure in one time and then applying MMC on the wound of the anterior commissure;D： excising experimental dog′s anterior cimmissure in one time,without any treatment.Result：All of the dog′s surgery were completed successfully by laser.Four weeks later,we observed the raw surfaces.A： the neonatal membrane covered the wound,inflammatory reaction slight,we could not see obvious adhesion in the anterior commissure.B： the membrane covered the wound,appearing the dark chronic inflammation,we could see the adhesion in the anterior commissure slight.C： the membrane covered the wound,edematization,we could see the moderate adhesion in the anterior commissure.D： edematization,we could see the adhesion in the anterior commissure obviously.Four groups were all appeared hoarsenesses,the most slightly in group A,secondly in B and C,the worst in D.The analysis of vocal cord length of 4 groups,we used matched-pairs t-test,A,B,C groups′P0.05,the vocal cord length didn′t become shorter than before obviously.Group D′s P0.01,that meant the vocal cord length became shorter obviously.Between each group,we used reiterature-measurement analysis of variance（P0.05）,the change of vocal cord length had disparity in different groups.The comparison in two groups suggested that group A is the best.B and C are inferior,but no disparity between them.The analysis of glottis area of 4 groups

关 键 词：激光手术 前连合 粘连 

分 类 号：R767.91[医药卫生—耳鼻咽喉科]