支撑喉镜下激光补充切除非完整剥离的残余声带囊肿21例

Analysis of 21 cases of residual vocal cord cyst excised by laser under suspension laryngoscope

摘要:

目的 探讨支撑喉镜下激光切除声带囊肿囊壁的疗效。方法 21例声带囊肿患者采用微瓣剥离技术分离破裂，再采用支撑喉镜下激光切除声带囊肿囊壁，于术后2周、2个月和6个月应用动态喉镜观察声带形态、声门闭合情况及患者声嘶改善情况。结果 21例患者手术顺利，术后即感声嘶改善，无出血，无窒息。术后2周复查，16例患者恢复良好；5例患者声音仍有嘶哑，声带稍有水肿，边缘黏膜欠平整。术后8周复查，20例患者恢复或接近正常嗓音，喉镜检查声带边缘平整、光滑；1例患者禁声不佳，仍有嘶哑，声带前中1/3处呈小结样微隆起。随访半年，仍有嘶哑的1例患者，伴声带小结，自觉声音能接受；无1例复发。1例左侧囊肿术后5个月对侧出现囊肿，经微瓣技术完整摘除后无复发。结论 采用支撑喉镜下激光补充切除非完整剥离的残余声带囊肿囊壁治疗声带囊肿，可彻底切除病变，又能很好地保留黏膜的完整性，利于发声功能恢复，是治疗破裂声带囊肿较好的手术方式。

Abstract:

Objective To investigate the curative effect of laser resection of vocal cord cyst under suspension laryngoscope.Methods 21 cases of vocal cord cyst failed to be separated by microflap dissection, then the cyst wall of vocal cord cyst was removed by laser under laryngoscope, and the morphology of vocal cord, closure of glottis and improvement of hoarseness were observed by dynamic laryngoscope at 2 weeks, 2 months and 6 months after the operation.Results The operation was successful in 21 patients whose hoarseness was improved immediately after operation, without bleeding or asphyxia. Two weeks later, 16 were recovered well while 5 were still with hoarse voices, slightly edematous vocal cords and unsmoothed marginal mucosas. Eight weeks after operation, 20 cases resumed or were close to regular voice with flat and smooth edges of vocal cord under laryngoscopy; besides, one patient had poor voice suppression, persisted hoarseness and 1/3 of the anterior and middle vocal cords showed nodule like micro uplift. After half a year of follow-up，the above-mentioned patient with hoarseness, accompanied by vocal nodules, felt that his voice was acceptable; and without any case recurred. One case had cyst on the opposite side 5 months after operation, with no recurrence after complete removal by microflap dissection.Conclusion Laser supplementary excision of the residual vocal cord cyst wall under laryngoscopy can completely remove the lesion and retain the integrity of mucous membrane, which is beneficial to the recovery of vocal function, and is a good surgical method for the treatment of broken vocal cord cyst.