喉内植入硅胶膜预防和治疗双侧声带粘连  

Endoscopic keel placementto treat and prevent bilateral vocal cord adhension

作　　者：陈健 吴海涛 程磊 何培杰 CHEN Jian;WU Haitao;CHENG Lei;HE Peijie(Department of Otorhinolaryngology Head and Neck Surgery,Eye Ear Nose Throat Hospital of Fudan University,Shanghai,200031,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院耳鼻咽喉头颈外科,上海200031

出　　处：《临床耳鼻咽喉头颈外科杂志》2018年第23期1821-1825,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：上海市科学技术委员会科研计划项目(No:15401971600)

摘　　要：目的:探讨喉内植入硅胶膜预防和治疗双侧声带粘连的效果及失败原因。方法:涉及前连合的双侧声带病变47例(预防组),显微喉镜下分别行双侧声带及前连合病变切除术;双侧声带粘连(喉蹼)38例(治疗组),CO2激光或剪刀切开粘连。上述85例患者术后均喉内植入硅胶膜,4周后取出,至少随访1年,观察创面变化,追踪粘连的预防和治疗效果。结果:47例双侧声带病变患者中,39例(83.0%)患者术后无粘连;而在38例双侧声带粘连患者中,28例(73.7%)患者术后无粘连。所有患者取出硅胶膜时有69例双声带前端为光滑表面,其中3例(4.35%)在随访中出现双侧声带粘连;16例双侧声带前端发现有白色假膜,其中15例(93.75%)在随访中出现双侧声带粘连(P<0.01)。结论:喉内植入硅胶膜是预防和治疗双侧声带粘连的有效方法,取出硅胶膜时双声带表面出现的白色假膜提示双声带术后粘连高风险。Objective:To investigate the effectiveness of endoscopic keel placement for the prevention and treat- ment of bilateral vocal cord adhesion.Method:There are 47cases with bilateral vocal cord lesions and 38cases with laryngeal adhesion in this study.Bilateral vocal cord lesions were removed and laryngeal adhesion was cut and divided.Afterwards,a silicone keel was placed in each case using a Lichtenberger endo-extralaryngeal needle carrier.The keel was removed 4weeks post-surgery and the vocal cords were observed using a laryngoscopy monthly. Result:During the 1-year follow-up,39(83.0%)cases with bilateral vocal cord lesions and 28(73.7%)cases with laryngeal adhesion did not develop laryngeal webs.A pseudomembrane covering the vocal cords was observed at the time of keel removal in 16cases of all.Unfortunately,15cases(93.75%)developed laryngeal webs among them.However,in the cases without a pseudomembrane,only 3(4.35%)cases formed glottic webs post-surgery (P<0.01).Conclusion:Endoscopic keel placement is an effective method for the prevention and treatment of bilateral vocal cord adhesion.The pseudomembrane detected at the time'of keel removal is probably a risk factor for the development of glottic webs.

关 键 词：前连合 声带疾病 硅胶膜 

分 类 号：R767.4[医药卫生—耳鼻咽喉科]