等离子射频联合喉模置入治疗病变广泛的复发性喉气管乳头状瘤的疗效分析

发布时间：2018-04-15 09:25

本文选题：喉乳头状瘤 + 复发　；参考：《临床耳鼻咽喉头颈外科杂志》2017年22期

【摘要】：目的:探讨等离子射频和喉腔支撑材料置入术治疗病变广泛的复发性喉气管乳头状瘤的可行性和远期疗效。方法:回顾性分析2009-03-2016-04期间收治的13例(男8例、女5例)复发性喉乳头状瘤成年患者,年龄28~67岁。本次就诊前均在外院接受过1~5次不同方式的外科处理,末次至本次手术间隔时间2~6个月。所有患者术前、术后均接受电子或频闪喉镜检查以及嗓音质量评估。全身麻醉支撑喉镜下行喉气管乳头状瘤等离子射频消融和喉腔支撑材料(硅胶片7例、硅胶管4例、T管2例)置入术。术后随访时间为12~76个月。结果:喉镜发现病变分别位于声带、前连合、室带、后连合、杓会厌皱襞、会厌等部位,部分累及声门下区和气管,均存在不同程度的前连合或(和)后连合等部位粘连,2例存在轻度气管狭窄。所有患者在术后2~6周拔除喉腔支撑材料,除2例2个月后再次发生前连合粘连,余均未发生明显的声带粘连或喉气管狭窄。术后的嗓音障碍指数和总嘶哑度均较术前明显改善。术后1年内复发3例,术后2年内复发4例,病变均位于室带、声门下区和气管内,随访期间未复发者6例。复发者再次接受射频消融术,随访期间内未再出现复发。该组病例未发生严重并发症。结论:等离子射频可满意切除病变广泛的复发性喉气管乳头状瘤,同时采用不同的支撑材料保护手术创面能有效地预防创面粘连和喉气管狭窄的发生,提高嗓音质量。
[Abstract]:Objective: to investigate the feasibility and long-term effect of plasma radiofrequency (RF) and laryngeal cavity support material implantation in the treatment of recurrent laryngeal papilloma.Methods: 13 patients (8 males and 5 females) with recurrent laryngeal papilloma, aged 2867 years, were retrospectively analyzed from 2009-03-2016-04.All the patients received 1 or 5 surgical treatments in different ways before the visit, and the interval between the last operation and this operation was 2 ~ 6 months.All patients underwent electronic or stroboscopic laryngoscopy and voice quality assessment before and after operation.Radiofrequency ablation of laryngotracheal papilloma and placement of laryngeal cavity support materials (7 cases with silica gel and 4 cases with T tube) were performed under general anaesthetized laryngoscope.The follow-up time was 12 ~ 76 months.Results: laryngoscopy showed that the lesions were located in the vocal cord, anterior ligation, ventricular zone, posterior ligation, arytenoid epiglottis fold, epiglottis, and some of them were involved in the subglottic area and trachea.There were 2 cases of mild tracheal stenosis in different degree of anterior and / or posterior synechia.All the patients removed the laryngeal cavity support material 2 weeks after operation, except for 2 cases with anterior conjunctive adhesion again after 2 months, and no significant vocal cord adhesion or laryngotracheal stenosis occurred in the remaining cases.Postoperative voice disturbance index and total hoarseness were significantly improved compared with preoperative.Recurrence occurred in 3 cases within 1 year and in 4 cases within 2 years after operation. The lesions were located in the ventricular zone, subglottic area and trachea. No recurrence occurred in 6 cases during the follow-up period.Recurrent patients underwent radiofrequency ablation, and no recurrence occurred during the follow-up period.There were no serious complications in this group.Conclusion: plasma radiofrequency can satisfactorily remove recurrent laryngotracheal papilloma with a wide range of pathological changes. At the same time, using different supporting materials to protect the wound surface can effectively prevent the occurrence of adhesion and laryngotracheal stenosis and improve the quality of voice.
【作者单位】：第二军医大学附属长海医院耳鼻咽喉头颈外科;
【分类号】：R739.65

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