低温等离子术后假膜脱落的临床讨论

发布时间：2018-06-02 20:02

本文选题：等离子射频消融术 + 手术　；参考：《临床耳鼻咽喉头颈外科杂志》2014年13期

【摘要】：目的:观察低温等离子术后假膜脱落情况,讨论由此可能带来的一些潜在问题。方法:以2012-11-2013-06期间行低温等离子手术的481例患者为研究对象,其中行扁桃体切除术116例,腺样体消融术98例,下鼻甲消融术255例,会厌囊肿切除术8例,喉部新生物切除术4例。重点观察术后假膜出现情况、脱落时间、脱落后伤口情况以及有无并发症发生。结果:扁桃体切除术后假膜脱落时间在2周左右,并发出血3例,其中1例与进食不当有关。腺样体消融术后2~3周假膜基本脱落,未出现后鼻孔狭窄及咽腔粘连等。会厌囊肿切除术后4周左右假膜脱落,并发出血1例。下鼻甲消融术后3~4周假膜脱落,1例患者在术后2个月并发大出血。1例左喉室神经鞘瘤患者术后4个月假膜才完全脱落,术区又长出新生物;1例左声带重度不典型增生伴原位癌患者术后4个月假膜还未完全脱落,术区亦可见新生物,术后9个月术区创面平整光滑,愈合好;1例左声门下上皮样血管内皮瘤患者术后第8天假膜完全脱落,随访至术后6个月未见复发;1例左侧杓会厌襞囊肿患者术后失访。前3例患者均未出现出血、内源性气管异物等并发症。结论:低温等离子手术具有明显优势,但术后假膜脱落带来的潜在问题值得引起足够重视,特别是低温等离子喉部新生物术后假膜脱落时间长短不一,与文献报道不完全一致,可能与其作用于周围组织的时间有关。
[Abstract]:Objective: to observe the pseudofilm shedding after hypothermic plasma surgery and discuss some potential problems. Methods: a total of 481 patients underwent hypothermia plasma surgery from 2012-11 to 2013-06 were studied, including 116 tonsillectomies, 98 adenoidectomy, 255 inferior turbinate ablation, 8 epiglottic cyst resection and 4 laryngectomy. The appearance of pseudomembrane, the time of shedding, the condition of wound after shedding and the occurrence of complications were observed. Results: after tonsillectomy, the pseudomembrane shedding time was about 2 weeks, and hemorrhage occurred in 3 cases, of which 1 case was related to improper feeding. After adenoid ablation, the pseudomembrane basically fell off at 2 ~ 3 weeks, no posterior nostril stenosis and pharyngeal cavity adhesion were found. About 4 weeks after excision of epiglottic cyst, the pseudomembrane fell off, and hemorrhage occurred in 1 case. After inferior turbinate ablation, the pseudomembrane shedding was found in 1 patient with massive hemorrhage 2 months after operation, and in 1 patient with left laryngoventricular neurilemmoma 4 months after operation. One patient with severe dysplasia of left vocal cord and carcinoma in situ had not completely shed the pseudomembrane and the new organism could be seen in the operation area. The wound surface of the operation area was smooth and smooth 9 months after operation. One patient with left subglottic epithelioid hemangioendothelioma completely lost the pseudomembrane on the 8th day after operation and was followed up for 6 months without recurrence. One patient with left arytenoid epiglottic fold cyst was lost after operation. The first three cases had no complications such as hemorrhage, endogenous trachea foreign body and so on. Conclusion: hypothermia plasma surgery has obvious advantages, but the potential problems caused by pseudomembrane shedding after operation should be paid enough attention to, especially the time of pseudomembranous shedding after hypothermic plasma surgery for new organisms of larynx is different, which is not completely consistent with the literature reports. It may be related to the time it acts on the surrounding tissue.
【作者单位】：恩施土家族苗族自治州中心医院耳鼻咽喉-头颈外科;
【分类号】：R762

【参考文献】