两种不同方式的声带息肉手术比较

目的比较全麻显微支撑喉镜和表麻电子喉镜下声带息肉摘除优缺点及术后的疗效.方法选取我院门诊声带息肉患者72例,随机分为两组,一组行支撑喉镜手术,另一组行电子喉镜手术,每组36例,每例患者均在术前及术后1月行电子喉镜检查及嗓音声学测试.结果支撑喉镜手术组一次性完成手术33例,改用电子喉镜下手术2例,需电子喉镜补充手术1例,电子喉镜手术组一次性完成手术35例,需2次完成手术1例.两组术后嗓音声学参数均明显优于手术前,统计学上差异有显著性意义(P＜0.05).结论电子喉镜下声带息肉摘除是微创手术,具有视野清晰、操作准确、创伤小、痛苦小、门诊手术、费用少等优点,能完成支撑喉镜下无法完成的手术,术后疗效和支撑喉镜下手术相仿.     

声带囊肿的诊断和治疗

报告25例声带囊肿。患者主要症状为声音嘶哑;电视频闪喉镜检查发现声带中1/3段边缘或表面有半圆形隆起,表面光滑,局部粘膜张力高,病变部位声带振幅减小,声门波减弱或消失。间接喉镜下诊断声带囊肿较为困难,确诊主要靠电视频闪喉镜或手术显微镜;术前正确诊断对提高手术疗效有意义;治疗以手术切除为主。     

支撑喉镜下声带息肉两种手术方式的疗效比较

目的探讨支撑喉镜下喉显微镜与肉眼下摘除声带息肉的疗效比较。方法回顾性分析声带息肉患者300例,随机分为两组,其中采用喉显微镜组150例,肉眼下摘除组150例。术后随访3个月,对比分析两组的疗效。结果复杂型及双侧声带息肉患者中喉显微镜组总有效率均高于肉眼组（P〈0．05）,而简单型及单侧声带息肉患者的总有效率两组之间的差异无统计学意义（P〉0．05）。结论支撑喉镜下手术治疗复杂型及双侧声带息肉喉显微镜组疗效优于肉眼组,而单纯型及单侧声带息肉则两组无明显差别。     

声带表皮样囊肿的喉显微手术

我科1989年3月-2002年3月收治声带病变1821例，病理证实表皮样囊肿37例。报告如下。     

小儿声带囊肿2例

例1。女，12岁。声嘶8年，渐进性加重，伴说话费力，无呼吸困难，于2003年12月5日入院。喉镜检查见右声带边缘隆起，声门闭合不全。术前半小时肌肉注射阿托品0．4mg，并建立静脉通道。患儿取平卧位，全身麻醉使声带相对固定不动，吸入麻醉维持，麻醉期间进行心电及血氧饱和度的动态监护；     

电子喉镜在声带囊肿切除术中的应用

声带囊肿是引起声嘶的常见病因之一。其治疗方法有显微支撑喉镜或纤维喉镜下声带囊肿切除术。我科从1998年12月～2002年2月采用电子喉镜下检查及治疗喉部疾病15922例，其中声带囊肿切除术73例，疗效满意。报告如下。     

声带囊肿的音声检查及喉内显微手术

对１２例声带囊肿作了音声检查和喉内显微手术。纤维动态喉镜录像检查可明确显示病变形状,病变部振幅变小、表面粘膜波消失,有助于鉴别诊断。喉发声分析示气流率升高、声时缩短、最高音下降、音域变窄。音声听觉心理评价主要为音声粗糙,兼有紧张,多伴有漏气。喉内显微手术术式分二种：粘膜下囊肿摘除术和带粘膜囊肿切除术。文中还讨论了中医对声带囊肿的认识。     

电视动态喉镜下实施声带手术

对于声带息肉、小结患者施以有关手术 ,以往多在支撑喉镜下或是间接喉镜下进行。 1 999年 5～1 0月 ,我们采用在电视动态喉镜下 ,实施声带息肉、小结、会厌囊肿摘除 ,以及行喉部活组织检查共 89例 ,取得良好效果。报道如下。1　资料与方法1 .1 　 临床资料89例中 ,男 2 5例 ,女 64例 ;年龄 1 8～ 76岁。均因声嘶和 (或 )咽异物感就诊 ,病程 2 0 d～ 3年。 89例中 ,声带小结 ( 型 ) 2 8例 (双侧 2 5例 ,单侧 3例 ) ,局限型声带息肉 ( 型 ) 1 7例 (单侧 1 5例 ,双侧2例 ) ,广基型 ( 型 ) 2 6例 (单侧 1 8例 ,双侧 8例 ) ,会厌囊肿 1 1例 ,喉部…     

纤维喉镜下声带微创手术191例报告

随着纤维喉镜的发展,纤维喉镜在喉微创外科中的运用越来越得到肯定.我科自2001年以Olympus enf typeP3纤维喉镜局麻下行声带病变手术共191例(其中9例为活体组织病理检查),均取得满意效果.现报道如下.     

Tonsillar cyst of the false vocal cord

OBJECTIVES/HYPOTHESIS: To report, for the first time, tonsillar cyst of the false vocal cord. STUDY DESIGN: Case report. METHODS: Case presentation and literature review. RESULTS: A 74-year-old woman with a mass in the false vocal cord presented with hoarseness. Histopathological examination revealed tonsillar cyst. Marsupialization via microlaryngeal approach failed. Finally the cyst was resected successfully through a lateral cervical approach with concomitant tracheotomy. CONCLUSIONS: This is the first report of tonsillar cyst in the false vocal cord in English literature. The cyst was finally resected through the lateral cervical approach with success.     

气管插管后声带运动障碍的原因及其相关因素

目的:分析气管插管全身麻醉术后声带运动障碍的原因及其相关因素。方法:通过电子喉镜、频闪喉镜检查、CT三维重建、杓状软骨拨动复位术治疗等判定135例全身麻醉术后声带运动障碍患者的原因。从患者插管条件与插管操作者技术水平、患者体态状况、年龄、带管时间、手术类别以及麻醉过程管理等方面分析声带运动障碍发生原因的相关因素。结果:135例患者中,128例(94.81%)声带运动障碍原因为杓状软骨脱位,7例(5.19%)为声带麻痹。声带运动障碍与插管困难有关者占76.30%;与麻醉过程起伏有关者达65.19%;在插管顺利的患者中,体态及颈部相对瘦长者占90.62%;不同年龄段所占比率差异无统计学意义;带管时间>12h的患者仅占全部声带运动障碍者的9.63%;心胸手术后出现声带运动障碍的发病率近0.50%,占全部声带运动障碍者的59.26%。结论:杓状软骨脱位及声带麻痹是全身麻醉术后声带运动障碍的主要原因;重视患者插管条件和麻醉过程管理,提高插管技术水平有可能降低声带运动障碍原因的发生。     

声带息肉的两种手术方法治疗疗效对比分析

目的比较支撑喉镜与电子喉镜下治疗不同类型声带息肉的疗效。方法回顾分析2005年6月~2006年1月我院162例声带息肉的患者,其中全麻支撑喉镜下手术76例,表麻电子喉镜下手术86例,治疗后1个月复查电子喉镜及进行嗓音声学评价。结果两种方式治疗声带息肉术前和术后嗓音声学比较差异有统计学意义(P<0.01),但在复杂型息肉中,支撑喉镜组术后嗓音声学参数优于电子喉镜组,经比较差异有统计学意义(P<0.05)。结论对于复杂型息肉首选支撑喉镜下手术;针对简单型息肉由于电子喉镜疗效确切并且方便,可作为首选方案。     

Paradoxical vocal cord movement in newborn and congenital idiopathic vocal cord paralysis: two of a kind?

The second most common cause of stridor reported in the newborn is bilateral vocal cord paralysis (BVCP) and one-third of the cases have been categorized as idiopathic. During the last year four children with stridor since birth were referred to our department for examination. Videotaped flexible laryngoscopy, carried out with the patient awake or under general anaesthesia with a spontanous respiration, revealed instead of abduction of the vocal cords during inspiration, rather an active adductory movement. Consequently instead of BVCP, we made the diagnosis paradoxical vocal cord movement (PVCM). One of the twins required a tracheostomy, the three other patients have been observed without the need of further treatment. No previous publications have described PVCM in newborn. However, our observations and video recordings clearly show that the stridor in our four patients is due to PVCM. This is possibly the same condition as earlier reported as congenital, idiopathic BVCP where incoordinated vocal cord movement or dyskinesia has been a part of the laryngoscopic findings. The mechanism behind PVCM in this age group or site of lesion is unclear.     

A Study of incidence and etiopathology of vocal cord paralysis

Vocal cord paralysis is not a disease per se but is considered as a sign of underlying disease process that may be congenital or acquired, unilateral or bilateral, sudden or gradual in onset, and may occur at any age from cradle to the grave. This study vas carried out to know the incidence and etiopathology of vocal cord paralysis.The incidence was 0.42% or 42 per ten thousand new patients seen. Most patients presented in the 5th and 6th decades (77.2%). Males outnumbered females in the ratio of 3:1. The most common symptom of vocaL cord paralysis was hoarseness of voice alone(83.6%.).Onset of symptoms was gradual in 60% of cases.Left vocal cord was almost twice more commonly (61.9%)involved than the right one(38.1%).Idiopalhic group constituted 38.18% of patients followed by neoplaslic diseases 29.09oc.     

The assistance of coblation in arytenoidectomy for vocal cord paralysis

Background: There are many causes for vocal cord paralysis, which can cause difficulty in breathing in serious cases. The common surgical methods for solving vocal cord paralysis include laryngeal splitting or laser surgery, but there are limitations. Plasma radiofrequency ablation is a new treatment with good achievements in clinical applications.

Objective: To investigate the effect of coblation-assisted arytenoidectomy (CSA) in the treatment of bilateral vocal cord paralysis (BVCP).

Methods: All patients had undergone preoperative electrolaryngoscopic examination of the glottidis rima; electronic laryngoscopy can assess the width of the glottis. The purpose of preoperative electronic laryngoscopic evaluation is to assess the width of the glottis, and arytenoid cartilage movement. Unilateral arytenoid cartilage and a section of the vocal cords were removed in all cases.

Results: Of the 14 patients, 13 were successfully extubated after CSA; 1 patient could not be extubated and underwent a second CSA of the contralateral arytenoid cartilage, after which extubation was achieved. All patients were continuously followed up (6 months to 2 years), and all achieved satisfactory results.

Conclusions and significance: CSA can effectively relieve post-CSA dyspnea in patients with BVCP. More patients underwent tracheal cannula extubation after tracheotomy compared with other surgeries.     

Volume analysis of preadipocyte injection for vocal cord medialization

OBJECTIVE: To compare the volume retention of injected preadipocytes with that of standard fat injection in a paralyzed rabbit true vocal cord. STUDY DESIGN: Prospective analysis with blinded data collection. METHODS: Thirteen New Zealand white rabbits were divided into two groups. Group 1 consisted of seven animals undergoing left-side vocal cord paralysis by resection of a 1-cm segment of the left-side recurrent laryngeal nerve and abdominal fat harvest for isolation of preadipocytes. Preadipocytes were cultured under sterile conditions in cell culture media. Animals in group 2 also underwent left-side vocal cord paralysis without fat harvest. After 10 to 14 days, in a second procedure, group 1 underwent injection of 0.1 mL cultured autologous preadipocytes, and group 2 underwent routine injection of 0.1 mL abdominal fat harvested during the same procedure. At 6 and 12 months, volumetric analysis was performed. RESULTS: Volume analysis at 6 months showed a mean volume of 0.029 mL retained fat in group 2 representing a retention of approximately 29% (SD = 0.023) of the original injected volume. Retention in group 1 animals approximated 0.002 mL (SD = 0.0024) or 2% of the injected volume. Analysis at 12 months showed a mean volume of 0.008 mL (SD = 0.0078) in group 2 and of 0.002 mL (SD = 0.0015) in group 1. Group 2 showed significantly higher volumes of the injected fat at 6 and 12 months (P <.033). CONCLUSION: Volumes obtained with standard fat injection were superior to those obtained with preadipocyte injection at both 6 and 12 months.     

Voice quality improvement after management of unilateral vocal cord paralysis with different techniques

The aim of this study was to objectively evaluate the voices of patients suffering from unilateral vocal cord paralysis, before and after endoscopic augmentation and thyroplasty. In the past, we used injectable Teflon to treat this condition; later techniques included collagen injection and Isshiki thyroplasty. In the last 7 years, preferred treatment methods have included Bioplastique injection and lipoaugmentation of the vocal cords as well as medialization thyroplasty using a titanium implant according to Friedrich. Pre- and postoperative data was evaluated and compared to 25 patients. Appropriate glottic closure of the vocal cords was achieved in every case, in most cases after the first intervention. We used voice range profile measurements to evaluate the results. An objective evaluation was performed using the Friedrich dysphonia index. Significant improvements were found: the dysphonia index decreased in every case, from an average of 2.47, preoperatively, to an average of 1.18 postoperatively. In agreement with earlier studies, voice pitch range was the only parameter that not significantly improved. There was no statistical difference between the lipoaugmentation and thyroplasty according to Friedrich. We concluded that both endoscopic methods and thyroplasty can be used to achieve an optimal result. Cases must be evaluated individually so that the best technique, or combination of methods can be determined.Presented at the 5th ELS Congress in Lisbon on 10-13 July 2004     

Suture lateralization of vocal cord treating paradoxical vocal cord movement: a case report

Paradoxical vocal cord movement (PVCM) causes inspiratory stridor and extra-thoracic airway obstruction through inappropriate adduction of the vocal cords during the respiratory cycle. We report on a patient with severe PVCM necessitating tracheostomy insertion. Using the technique of endoscopic suture lateralization of a vocal cord, we succeeded in decannulation 22 years after tracheostomy. PVCM of this severity is rare and its management remains unclear. Successful treatment in this manner has not been documented previously. A brief review of current management options for this condition is included.