声带良性病变声门暴露困难原因及对策

摘要

Objective To discuss the cause and countermeasure of the vocal cords benign lesions difficult surgery glottis exposure (DLE). Methods The body mass surgery (BMI),neck circumference,tongue back height assessment (MMT),thyroid cartilage and the thyroid cartilage to medial border distance (TMD) of 67 patients with DLE were added to preoperative assessment,and the way of operation under endoscopy or equipment using methods were improved,such as:①Increased with anesthesia nondepolarizing agent dosage,used small endotracheal intubation and high frequency jet ventilation. ② The paraffin oil lubrication support wall to avoid epiglottis varus. ③ To switch to adjustable support laryngoscope.④ Adjustable support laryngoscope vocal cords surgery under cystoscope. ⑤ Adjustable support laryngoscope under cystoscope plasma throat under the knife cut. ⑥ Split or laryngeal surgery under electronic laryngoscope. Results 67 patients were successfully completed surgery and followed up for 3 to 6 months,vocal cord back to normal. Conclusion Preoperative of DLE patients with preoperative assessment has important clinical significance. Of DLE patients,the ways to solve the glottis exposure is more,each has advantages and disadvantages,should be flexible according to the practical situation in clinical application.%目的 探讨声带良性病变手术声门暴露困难(DLE)的原因及对策.方法 对67例DLE患者身体质量指数(BMI),颈围,舌背高度评估(MMT)及甲状软骨上切至颏突内侧缘的距离(TMD)进行术前评估,并在内镜下改进手术方式或改善器械使用等方法(1)加涂麻醉药增加肌松剂剂量,改用小号气管插管及高频喷射通气.(2)石蜡油润滑支撑管壁避免会厌内翻.(3)改用可调式支撑喉镜.(4)可调式支撑喉镜下膀胱镜下声带手术.(5)可调式支撑喉镜下膀胱镜下等离子喉刀吸切.(6)电子喉镜下或喉裂开进行手术.结果 67例患者顺利完成手术,随访3～6个月,声带恢复正常.结论 术前对DLE患者进行术前评估具有重要临床意义.对DLE患者,解决声门暴露的方法较多,各具有优缺点,在临床中要根据实际情况灵活应用.