防止喉部前连合手术后粘连的动物实验研究

发布时间：2018-06-13 03:44

本文选题：激光手术 + 前连合　；参考：《宁夏医科大学》2011年硕士论文

【摘要】：目的探讨激光手术治疗喉部前连合疾病时,既可以切除病变,同时又可以避免术后前连合粘连、喉狭窄及呼吸困难的较理想手术方法。方法将12只实验犬随机分成4组,每组3只。A组分两次手术切除实验犬前连合,间隔时间为2周;B组一次性切除实验犬前连合,同时以硅胶膜片缝合固定于前连合处,2周后拆除硅胶膜;C组一次性切除前连合,术后前连合创面蘸涂丝裂霉素-C(MMC)按压5分钟;D组一次性切除前连合,术后创面不做其它处理。4周后电子喉镜下观察各组创面恢复情况,并且术前、术后分别测量各组实验犬声带长度及声门面积,比较其变化;各组前连合标本制作病理切片,常规HE染色及VG染色比较其组织学差异。结果全部实验犬均在激光下顺利按计划完成手术,术后4周创面观察:A组创面有新生粘膜覆盖,炎症反应轻,前连合无明显粘连;B组创面粘膜覆盖,局部见暗红色慢性炎症改变,前连合轻度粘连;C组创面粘膜覆盖,术区水肿,前连合中度粘连;D组术区肿胀,前连合明显粘连。A、B、C、D四组犬吠均有不同程度的声嘶,A组最轻,B、C组次之,D组最重。4组实验犬声带长度资料分析:组内比较采用配对t检验,A、B、C三组P0.05,无统计学意义,说明声带长度术后较术前缩短不明显,D组P0.05,说明声带长度术后较术前明显缩短;组间比较采用重复测量方差分析(P0.05)说明不同处理组间声带长度变化有差异。经两两比较,认为A组效果最好,B、C组次之,两者之间无明显差异。4组实验犬声门面积资料分析:组内比较采用配对t检验,A、B两组P0.05,无统计学意义,说明声门面积术前术后变化不明显,C、D两组P0.05,说明声门面积术后较术前明显缩小;组间比较采用重复测量方差分析(P0.05),尚不能认为四组之间声门面积变化有明显差异。病理切片观察,常规HE染色显示:A组组织水肿,粘膜下层有裂隙状血管,少量中性粒细胞及淋巴细胞浸润;B组、C组间质内透明变性比较明显,可见中性粒细胞及淋巴细胞浸润,伴有新生毛细血管增生;D组见粘膜下有较多中性粒细胞及淋巴细胞浸润,伴多量小血管增生。VG染色显示:损伤后的组织中含有大量的胶原纤维,其中A组最少,B组中等,C组含量较多,D组最多。结论激光手术切除实验犬前连合,通过4种不同的术式比较,A组防止术后粘连效果最好,B组、C组次之,D组最差。本实验结果对临床中应用激光治疗侵犯至前连合病变的术式选择有一定的参考价值。
[Abstract]:Objective to explore the ideal method of laser surgery for the treatment of anterior laryngeal ligation disease, which can not only remove the lesion, but also avoid postoperative anterior conjunctive adhesion, laryngeal stenosis and dyspnea. Methods Twelve experimental dogs were randomly divided into 4 groups, 3 dogs in each group were divided into two groups: the anterior conjunctions of experimental dogs were resected twice, the interval time was 2 weeks and the interval was 2 weeks, group B had a one-off excision of the anterior conjunctions of experimental dogs. At the same time, the silicone film was sutured and fixed at the anterior junction for 2 weeks. After removing the silicone film, group C had a single resection of the anterior conjunct, and the wound of the anterior conjunctive wound was dipped with mitomycin-Con MMC. after operation, the group D was pressed for 5 minutes. The wound recovery was observed under electronic laryngoscope after 4 weeks without other treatment. Before and after operation, the length of vocal cord and glottic area of experimental dogs in each group were measured, and the changes of glottic area were compared. Histological differences were compared between routine HE staining and VG staining. Results all the dogs were successfully operated according to the plan under laser irradiation. The wounds of group A were covered with new mucosa and the inflammatory reaction was light at 4 weeks after operation. There was no obvious adhesion of anterior ligation and no obvious adhesion of mucous membrane in group B. Local changes of dark red chronic inflammation were observed in group C with mild anterior synechia, mucosal coverage, edema in operation area and swelling in group D with moderate anterior conjunctions. The data of vocal cord length in group A and group C, followed by group D, were analyzed. The data of vocal cord length in group A were compared with that in group C (pairing t test) (P 0.05), and there was no significant difference between group A and group C (P > 0.05). The results showed that the length of vocal cord after operation was not significantly shorter than that before operation in group D, and the length of vocal cord after operation was significantly shorter than that before operation, and the differences in length of vocal cord between groups by repeated measurement of variance analysis of variance (P0.05) indicated that there were differences in the length of vocal cord among different treatment groups. It was concluded that group A had the best effect in group C, and there was no significant difference between the two groups. 4. Analysis of glottic area data of experimental dogs in group 4: there was no significant difference between group A and group B by paired t test (P0.05), and there was no significant difference between group A and group B (P < 0.05). The results showed that the glottic area was not significantly changed before and after operation in two groups, indicating that the glottic area was significantly reduced after operation, and that there was no significant difference in glottic area between the four groups by repeated measurement of variance analysis of variance (P0.05). Histopathological observation showed that tissue edema and fissure vessels were found in the submucosa of group A with routine HE staining. A small amount of neutrophils and lymphocytes infiltrated the interstitial cells of group B and the interstitial hyaline degeneration in group B was more obvious, and neutrophil and lymphocyte infiltration were observed in group C, and neutrophil and lymphocyte infiltration were observed. In group D, neutrophilic granulocyte and lymphocyte infiltration were found in the submucous membrane, and VG staining showed that there was a large number of collagen fibers in the injured tissue. Among them, group A, B, group B, group C were more than group D, the content was the most. Conclusion after laser resection of experimental dogs, the effect of preventing postoperative adhesion in group A is the best and that in group C is the worst, and that in group D is the worst. The results of this study have some reference value for clinical application of laser in the treatment of anterior ligation lesions.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R767

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