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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。
OBJECTIVE: To observe the limit of the vertical hemipethra of semiconductor laser-burning dogs and to provide a reference for investigating the excision range of partial laryngectomy in laryngeal cancer. Methods: Twelve dogs were randomly divided into three groups (A, B, C, n = 4) according to the range of vertical hemilaryngectomy. A group: the anterior resection combined with the thyroid cartilage endometrium, excision The right vocal cord; Group B: before the anterior resection combined to the thyroid cartilage endometrium and part of the anterior cartilage, outward removal of the right ventricular zone, vocal fold, subtennis and some of the circumferiorus, cut down to thyroid cartilage C group: part of the thyroid cartilage before combined resection and anterior commissure, outward resection of the right ventricular band, vocal fold, subtenone, circumflex muscle and the glottis space Thyroid cartilage plate, cut down part of the annular membrane to the upper edge of the annular cartilage, complete removal of the right arytenoid cartilage. Immediately after surgery, 1 week and 4 weeks were observed in each group canine wound recovery, dog bark hoarseness and postoperative complications, etc., evaluate the effect. Results: One week after operation, the laryngoscope was seen that the nasal mucosa was covered in the surgical wounds in group A and B, and the nasal mucosa in group C was incompletely covered with some signs of infection. A, B group no obvious complications, C group eating cough. After 4 weeks, the laryngoscope was seen that the mucosa of each wound surface was smooth and the former joint adhered to form a throat web and a new anterior joint. In group A, the formation of new vocal cords was observed. The glottis closed with only a small gap. The new vocal cords in group B were narrower than those in the contralateral side, and the vocal folds were not closed completely. In group C, only slight mucosal uplift was seen in the vocal cords and the glottis was severely closed. A group no obvious hoarseness, B group moderate, C group heavy hoarseness, eating cough disappeared. Group C thoracic articular cartilage thinner than the contralateral. CONCLUSION: When the vertical semicircular laminectomy is performed in the semiconductor laser ablation dogs, the medial soft tissue of the thyroid cartilage can be excised completely, including the arytenoid cartilage and the part of the thyroid cartilage at the anterior commissure. Satisfactory repair can be obtained without any obvious complications.