激光喉部肿瘤手术并发症的预防及处理  

Prevention and management of complications in laser surgery for laryngeal neoplasms

作　　者：马超武[1] 黄益灯 刘丹 罗兴华 孙广滨[3] 夏思文 梁耕田[4] 周水淼[5] 

机构地区：[1]解放军第117医院耳鼻咽喉头颈外科,杭州市310013 [2]解放军第118医院耳鼻咽喉头颈外科,温州市325000 [3]上海市浦东新区公利医院 [4]浙江省台州医院 [5]第二军医大学附属长海医院,上海市200433

出　　处：《实用医学杂志》2011年第15期2730-2733,共4页The Journal of Practical Medicine

基　　金：南京军区卫生专业人才培养122工程基金资助项目(编号:卫计2007038);南京军区重大专项课题基金资助(编号:08Z007)

摘　　要：目的:探讨激光喉部肿瘤手术并发症的预防及处理。方法:1999年4月至2010年8月以来多中心共1158例喉肿瘤患者使用Diamod激光、Nd:YAG激光、CO2激光行喉部肿瘤切除术,对术后并发症进行回顾性分析,对并发症提出预防及处理策略。结果:激光引起的并发症110例,占9.50%,术中呼吸道烧伤1例,占0.08%,术后声带粘连72例,占6.21%,术后出血20例,占1.72%,颈部皮下气肿及颈部瘘管7例,占0.60%,呼吸困难6例,占0.52%,局部感染伴颈前脓肿3例,占0.30%,术后吞咽困难及吸入性肺炎1例,占0.08%。结论:激光治疗喉部肿瘤并发症是相对常见的,外科医师必须非常清楚并发症的预防及处理策略。并发症的发生与肿瘤的位置有关,肿瘤侵犯前联合,术后并发症增加;还与术者的经验、支撑喉镜下肿瘤的暴露效果有关。Objective To study the prevention and treatment of complications in laser surgery for laryngeal neoplasms. Methods A total of 1 158 patients were treated with Diomed laser, Nd： YAG laser, or CO2 laser in multi-medical center from April 1999 to August 2010. The intraoperative and postoperative complications were retrospectively analyzed. Results Complications caused by laser were found in 110 cases （9.50%）, which included airway ignition （0.08%）, laryngeal synechia （6.21%）, postoperative bleeding （ 1.72% ）, cervical subcutaneous emphysema or cervical cutaneous fistula （0.60%）, dyspnea （0.52%）, local infection or cervical abscess （0.30%）, and swallowing difficulty or aspiration pneumonia （0.08%）. Conclusions The complications in laser surgery for laryngeal neoplasms are relatively frequent. Every surgeon who performs laser surgery should have a clear concept of management for these complications, and strategies to avoid these complications should be performed. The complications are associated with the tumor location, tumor involved anterior commissure, surgeon experience, and tumor exposure.

关 键 词：喉肿瘤 激光手术 手术后并发症 

分 类 号：R739.65[医药卫生—肿瘤]