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頭頸外科醫(yī)學(xué)論文-甲狀腺葉切除術(shù)后咽喉部充血水腫的原因探討及預(yù)防
【摘要】目的 探討甲狀腺腫瘤行喉返神經(jīng)解剖+腺葉切除術(shù)后咽喉部疼痛充血水腫(并發(fā)癥)的原因及預(yù)防措施。方法 回顧性分析159例甲狀腺腫瘤行喉返神經(jīng)解剖+腺葉切除術(shù)的手術(shù)資料及術(shù)后出現(xiàn)咽喉部疼痛充血水腫等癥狀體征及輔助檢查資料，包括手術(shù)時(shí)間與癥狀等，對(duì)產(chǎn)生并發(fā)癥的原因進(jìn)行分析。結(jié)果 159例發(fā)生輕度重度咽喉部疼痛107例(67.30%)，檢查患側(cè)單部位血水腫(會(huì)厭、會(huì)厭谷、披裂、室?guī)�、聲�?37例，2處43例，3處11例，多部位16例，以披裂單發(fā)多見(jiàn)，時(shí)間為術(shù)后1～7 d。處理方法：術(shù)后常規(guī)抗生素抗炎，局部霧化吸入，嚴(yán)重病例肌內(nèi)注射或靜脈點(diǎn)滴地塞米松5～10 mg，并做好氣管切開(kāi)準(zhǔn)備。出院后隨訪3個(gè)月恢復(fù)。呼吸困難者即刻行氣管切開(kāi)術(shù)，打開(kāi)傷口，清理血腫，抗炎對(duì)癥，癥狀體征消失后7 d堵管48 h后拔管愈合。結(jié)論 該手術(shù)術(shù)式保護(hù)了喉返神經(jīng)，降低了喉返神經(jīng)損傷發(fā)生率，但影響了喉的血管淋巴循環(huán)，可能損傷了喉上神經(jīng)。手術(shù)要操作輕柔，解剖層次更清晰，更應(yīng)保護(hù)除腫瘤以外的正常組織醫(yī)學(xué)全.在.線m.zxtf.net.cn。
【關(guān)鍵詞】 甲狀腺腫瘤 解剖 甲狀腺腺葉切除術(shù) 并發(fā)癥 Exploration of the causes and preventive measure of congestion and edema in pars laryngea pharynges of patients with thyroid neoplasm after thyroidectomy YANG Caihong*, LU Honghua，JIN Guowei*,et al.*Department of Otolaryngology, Tianjin Fourth Central Hospital, Tianjin 300140,China
【Abstract】 Objective To investigate the causes and preventive measure for pain, congestion and edema in pars laryngea pharynges of patients with thyroid neoplasm after recurrent laryngeal nerve (RLN) anatomy and thyroidectomy. Methods The clinical data of 159 patients thyroid neoplasm who underwent RLN anatomy and thyroidectomy,with postoperative complications and auxiliary examinations including pain, congestion and edema in pars laryngea pharynges,operation time,symptoms and signs, were retrospectively analyzed in order to explore the causes of complications.Results Among 159 patients, there were 107 patients (67.29%) had pharyngeal pain, bung and breath holding with congestion and edema of laryngopharyngeal mucous confirmed by indirect laryngoscope or strobolaryngoscope. The epiglottis, epiglottic vallecula, epiglottic fold, ventricular bands of broken side and the epiglottic fold of opposite side were affected. One patient had hoarseness, one patient had breath holding and dyspnea.Conclusion This operation method can protect the recurrent laryngeal nerve and reduce the incidence of recurrent laryngeal nerve damage, but affect the blood vessel and lymph circulation, and may even injure superior laryngeal nerve. So we should operate softly, make anatomical layer more clearly and protect the normal pars outside the tumor tissue.
