支撑喉镜手术中重度声门暴露困难的处理

Management of severe glottis exposure difficulty during suspension laryngoscopic surgery

摘要:

目的 总结抬举支撑喉镜尾端处理重度声门暴露困难的临床应用效果。方法 回顾性分析2021年1月－2024年1月该院收治的在支撑喉镜手术中出现重度声门暴露困难（Cormack-Lehane分级为Ⅲ级或Ⅳ级）的25例患者的临床资料，对术中的处理方法和结果进行分析。结果 所有患者在支撑喉镜角度调节到最大仍无法满意暴露声门后，通过抬举支撑喉镜支架尾端的方法，以获得更大倾斜角度和视野。支架尾端抬高（11.50±6.31）cm后，23例声门暴露满意并顺利实施手术；2例失败，改用喉罩配合纤维喉镜，利用喉钳逐步钳取病变。24例出现咽壁黏膜撕裂和渗血，电凝后出血停止；1例出现牙齿松动并脱落。支架抬举前后患者血压和心率比较，差异均无统计学意义（P > 0.05）。结论 对于支撑喉镜术中出现的严重声门暴露困难，可以通过抬举支架尾端进行处理，此方法简单、有效，不会引发严重并发症，值得临床推广应用。

Abstract:

Objective Summarize the clinical application and elevating the caudal end of suspension laryngoscope to deal with severe glottis exposure difficulties.Method A retrospective analysis was conducted on the clinical data of 25 patients with severe dystotic glottic exposure (Cormack-Lehane grade III or IV) who underwent laryngoscopy support surgery from January 2021 to January 2024, then analyze the intraoperative management and outcomes.Results In all the patients, after the angle of the suspension laryngoscope was adjusted to the maximum and the glottis could not be exposed satisfactorily, the caudal end of the suspension laryngoscope stent was lifted to obtain a larger tilt angle and field of view. After the caudal end of the stent was elevated by (11.50 ± 6.31) cm, the glottis was exposed satisfactorily in 23 cases and the operation was performed successfully; In 2 cases, the laryngeal mask airway was used in conjunction with a fibrolaryngoscope and laryngeal forceps were used to extract the lesion step by step. Pharyngeal mucosal tearing and oozing of blood occurred in 24 cases, and the bleeding stopped after electrocoagulation; one case had loose and dislodged teeth. There were no significant changes in blood pressure and heart rate of patients before and after stent lifting (P > 0.05).Conclusion For the severe difficulty of glottis exposure during suspension laryngoscopic surgery, it can be dealt with by lifting the caudal end of the stent, which is a simple and effective method that does not cause serious complications and is worth clinical application.