| 摘要: |
| 目的:观察半导体激光烧灼犬垂直半喉的极限范围，为探讨临床喉癌激光部分垂直半喉切除术的切除范围提供参考。方法:12只实验犬按半导体激光垂直半喉切除范围的不同随机分为3组(A、B、C,n=4),A组:向前切除前联合至甲状软骨内膜,向外切除右侧声带;B组:向前切除前联合至甲状软骨内膜及部分前联合软骨,向外切除右侧室带、声带、甲杓肌及部分环杓侧肌,向下切除至甲状软骨下缘,向后切除部分杓状软骨;C组:向前切除前联合及前联合处部分甲状软骨,向外切除右侧室带、声带、甲杓肌、环杓侧肌及声门旁间隙达甲状软骨板,向下切除部分环甲膜至环状软骨上缘,向后完全切除右侧杓状软骨。术后即刻、1周和4周分别观察各组犬创面恢复情况、犬吠声嘶情况及术后并发症发生情况等,评价术后疗效。结果:术后1周喉镜下见:A、B组手术创面即有新生黏膜覆盖;C组创面新生黏膜覆盖不全,局部有感染迹象。A、B组无明显术后并发症,C组并发进食呛咳。4周后喉镜下见:各组创面黏膜表面光滑,前联合处粘连形成喉蹼并有新的前联合。A组术侧见新声带形成,声门关闭仅见小缝隙;B组新声带较健侧窄、薄,声门关闭不全;C组原声带处仅见黏膜微微隆起,声门严重关闭不全。A组无明显声嘶,B组中度,C组声嘶较重,进食呛咳消失。C组术侧甲状软骨板较对侧变薄。结论:半导体激光烧灼实验犬垂直半喉极限切除时,可将甲状软骨板内侧软组织全部切除,包括杓状软骨和前联合处部分甲状软骨,术后可以得到满意的修复而无明显并发症。 |
| 关键词: 垂直半喉切除术 激光 声带 甲状软骨内膜 杓状软骨 |
| DOI：10.3724/SP.J.1008.2009.00032 |
| 投稿时间：2008-03-31修订日期：2008-07-08 |
| 基金项目:上海市浦东新区社发局立项课题(PW2006A-15). |
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| Resection range of dog hemi-vertical larynx by semiconductor laser |
| FANG Qin1,SUN Guang-bin1*,LIANG Geng-tian2,XU Wei-hua1,XU Li-min2,ZHOU Shui-miao3 |
| (1.Department of Otolaryngology,Gongli Hospital,Pudong New Area,Shanghai 200135,China* 2.Department of Otolaryngology,Taizhou Hospital of Zhejiang Province,Taizhou 317000* 3.Department of Otolaryngology,Changhai Hospital,Second Military Medical University,Shanghai 200433) |
| Abstract: |
| Objective:To observe the resection range of dog hemi-vertical larynx by semiconductor laser.Methods: Twelve dogs were randomly divided into three groups (A,B and C,n=4).Group A: the hemi-vertical larynx was cauterized forward from the anterior commissure to thyroid cartilage internal membrane,outwards including the right vocal cords.Group B: the hemi-vertical larynx was cauterized forward from anterior commissure to thyroid cartilage internal membrane and partial cartilage of anterior commissure,outwards including the right ventricular fold,vocal cord,thyroarytenoid muscle and partial lateral cricoarytenoid muscle,downwards including the lower edge of thyroid cartilage,and backwards including the partial arytenoid cartilage.Group C: the hemi-vertical larynx was cauterized forward including the anterior commissure and partial thyroid cartilage of anterior commissure,outwards including the right ventricular fold,vocal cord,thyroarytenoid muscle,lateral cricoarytenoid muscle and paraglottic space to thyroid cartilage,downwards including the partial cricothyroid membrane to the upside of cricoid cartilage,and backwards including total right arytenoid cartilage.The recovery of the laryngeal wounds,hoarseness,and complications were observed and evaluated by using digital camera and electrolaryngoscope immediately,1 week and 4 weeks after operation.The treatment outcome of the resection was evaluated.Results: The laser surgery was completed successfully in all the animals.Laryngoscope showed that the neonatal membrane covered the wound in group A and B one week later,without obvious complications.The neonatal membrane covered part of the wound in group C,accompanied by inflammatory reaction and cough when eating.Four weeks later the new membrane over the wound surface were smooth in all the three groups; adhesion appeared in the anterior commissure and new anterior commissure was formed.A new vocal cord was formed in group A; only a small gap was seen when the glottis was closed.In Group B,the new vocal cord was narrower and thinner; granulation growth was seen in local areas; and the glottis was closed incompletely.In Group C,mucosa was slightly raised over the original location of the vocal cord.Closure of the glottis was poor.Group A had no hoarseness,Group B had moderate,and Group C had severe hoarseness,but without cough when eating.Also in Group C the lamina of thyroid cartilage of the operative side was thinner than that of the contralateral side.Conclusion: When cauterizing dog partial hemi-vertical larynx using semiconductor laser,we can resect all the soft-tissue internal the thyroid cartilage,including the arytenoid and partial thyroid cartilage in the anterior commissure.The repair is satisfactory after operation,without obvious complications. |
| Key words: hemi-vertical laryngectomy laser vocal cords thyroid cartilage internal membrane arytenoid cartilage |
