低温等离子技术联合T型管植入术治疗成人喉及上端气管狭窄的随机对照研究

摘要

目的：比较低温等离子与电刀切除联合T型管植入术治疗成人喉及上端气管狭窄的效果。方法采用密闭信封法将2008年1月～2011年11月24例成人喉及上端气管狭窄随机分为等离子组和电刀组。等离子组喉及上端气管内瘢痕采用美国ArthroCare公司低温等离子Reflex72刀头切割消融喉及上端气管内瘢痕，电刀组采用电刀切除喉及上端气管内瘢痕，2组均联合T型硅胶管植入术。结果等离子组术后次日试堵管有效10例，显著高于电刀组4例（ Z＝-2．432，P＝0.039）；术后1周试堵管有效12例，显著高于电刀组5例（Z＝-3．077，P＝0．002）。等离子组治愈11例，电刀组7例，2组比较无统计学差异（Fisher’s检验，P＝0．155）。等离子组术后T型管拔除后狭窄部分瘢痕增生2例，显著少于电刀组8例（Fisher’s检验，P＝0.036）；等离子组T型管拔除后呼吸困难0例，电刀组1例，2组比较无统计学差异（Fisher’s检验，P＝1.000）；等离子组术后切口出血2例，电刀组6例，2组比较无统计学差异（Fisher’s检验，P＝0．193）；等离子组皮下气肿0例，电刀组3例，2组比较无统计学差异（Fisher’s检验，P＝0．217）。术后24个月等离子组狭窄部位肉芽组织增生2例，电刀组5例，2组比较无统计学差异（Fisher’s检验，P＝0．371）。结论低温等离子的近期疗效优于电刀切除，不良反应少于电刀切除。%Objective To compare the effectiveness between low-temperature plasma radiofrequency with T-tube implantation and electric knife resection with T-tube implantation in the treatment of laryngeal and subglottic stenosis in adult patients . Methods A total of 24 patients with laryngeal and subglottic stenosis from January 2008 to November 2011 were randomly divided into either experimental or control groups .The experimental group was given low-temperature plasma radiofrequency with T-tube implantation , whereas the control group was given electric knife resection with T-tube implantation . Results There were 10 effective cases in the experimental group at the first postoperative day , which was significantly more than 4 cases in the control group ( Z=-2.432, P=0.039).One week after the operation, there were 12 effective cases in the experimental group , which was significantly more than 5 cases in the control group (Z=-3.077, P=0.002).Eleven patients were cured in the experimental group , while 7 patients were cured in the control group, without significant difference between the two groups (Fisher’s test,P=0.155).After the removal of the T-tube, scar hyperplasia was observed in 2 cases in the experimental group and in 8 cases in the control group , with significant difference (Fisher’s test,P=0.036).There were no significant differences between the experimental group and the control group in dyspnea rate (0 case vs.1 case, Fisher’ s test,P=1.000), postoperative hemorrhage (2 cases vs.6 cases, Fisher’ s test,P=0.193), and subcutaneous emphysema (0 case vs.3 cases, Fisher’s test,P=0.217), respectively.Twenty-four months following the operation, hyperblastosis of granulation tissue at the site of stenosis was recorded in 2 case in the experimental group and in 5 cases in the control group, without significant difference ( Fisher ’ s test, P =0.371 ). Conclusion Low-temperature plasma radiofrequency with T-tube implantation is more effective than electric knife resection with T-tube implantation , with fewer adverse events.