目的 了解喉不返神經臨床解剖特點，總結甲狀腺手術中預防其損傷的經驗。方法 分析2例喉不返神經臨床資料，結合文獻討論甲狀腺手術中預防其損傷的有關問題。結果 本組2例經手術證實，喉不返神經均位于右側； 右喉返神經缺如，術中未損傷。結論 甲狀腺手術中發現橫行于頸動脈鞘和喉之間任何索狀結構或探查喉返神經缺如，須顯露迷走神經(頸段)以避免損傷喉不返神經。
目的 評價喉罩聯合T型密封接頭通氣在新生兒無痛纖維支氣管鏡（纖支鏡）診治中的臨床效果。 方法 對2010年3月－2012年10月收治的33例擬行纖支鏡診治的新生患兒，分為喉罩組（Ⅰ組）和常規組（Ⅱ組），兩組患兒在術前半小時均靜脈注射咪唑安定0.2～0.3 mg/kg基礎上，Ⅰ組靜脈注射枸櫞酸芬太尼3～5 μg/kg，置入喉罩聯合T型密封接頭通氣下行纖支鏡診治；Ⅱ組常規表面麻醉下行纖支鏡診治。分析術前（T1）、通過聲門（T2）、診治中（T3）、檢查后（T4），脈搏血氧飽和度（SpO2）、心率（HR）的變化情況、纖支鏡從T型密封接頭入口或鼻孔到通過聲門的時間、鏡檢時間、支氣管肺泡灌洗次數、鏡檢期間不良反應（嗆咳、憋氣、肢體運動、呼吸道損傷）及麻醉滿意度（由內鏡醫師評價）。 結果 Ⅰ組與Ⅱ組比較，T1、T4時間點SpO2、HR差異無統計學意義，T2、T3時間點SpO2＜85%、HR＜100次/min的發生率Ⅰ組與Ⅱ組比較差異有統計學意義（P＜0.01）；纖支鏡從T型密封接頭入口或鼻孔到通過聲門時間差異無統計學意義（P＞0.05）；Ⅱ組鏡檢時間短于Ⅰ組，支氣管肺泡灌洗次數少于Ⅰ組；Ⅰ組不良反應低于Ⅱ組，麻醉滿意度高于Ⅱ組（P＜0.05）。 結論 喉罩聯合T型密封接頭通氣在新生兒無痛纖支鏡診治氣道管理安全有效可行，醫師能從容操作。
Objective To study the effectiveness of one-stage repairing pharyngeal defect with the tongue flaps after resection of advanced stage hypopharyngeal neoplasm and laryngeal neoplasm. Methods Between June 2006 and March 2011, 20 patients with hypopharyngeal neoplasm (8 cases) and laryngeal neoplasm (12 cases) with advanced stage were treated. There were 19 males and 1 female, aged 47-78 years (mean, 62.8 years). All neoplasms were squamous cell carcinomas. The disease duration was 1-8.5 months (mean, 3.9 months). According to the standards of International Union Against Cancer (UICC, 1987), 12 cases were in stage III and 8 cases were in stage IV. The size of pharyngeal defect was 5 cm × 2 cm to 4 cm × 4 cm after resection of tumor. Defects were repaired by the whole base of the tongue flaps in 16 cases and by the horizontal base of the tongue flaps in 4 cases. The size of the flaps ranged from 5 cm × 2 cm to 4 cm × 4 cm. Postoperative radiotherapy and chemotherapy were regularly performed. Results The 20 tongue flaps were alive. Healing of incision by first intention was achieved in 18 cases and delayed healing in 2 cases because of subcutaneous fluid. The patients were followed up 12-63 months (mean, 36.7 months). The patients had normal feeding ability and tongue function. Of 20 cases, 12 died and 1 of local recurrence was alive with tumor. The 3-year survival rate was 69.2% (9/13). Conclusion One-stage repair of pharyngeal defect with the tongue flaps after resection of hypopharyngeal neoplasm and laryngeal neoplasm can obtain good effectiveness because the tongue flap is easy-to-obtain and easy-to-survive, and has abundant blood supply.
Objective To investigate the causes and treatment of recurrent laryngeal nerve （RLN） injury during the operation of thyroidectomy. Methods Clinical data of 48 patients that RLN were injured during thyroidectomy in and out of our hospital from Jun. 2003 to Mar. 2007 were reviewed. Results No patient died while operation and staying in hospital. There were 47 cases of unilateral RLN injury, 1 case of bilateral RLN injury; 21 cases （43.7%） were injured because of suture or scar adhesion, 13 cases （27.1%） were partly broken with formed scar, 14 cases （29.2%） were completely cut off; The locations of RLN injuries were closely adjacent to the crossing of the inferior thyroid artery and RLN in 13 cases （27.1%） and 35 cases （72.9%） were within 2 cm below the point of RLN entering into throat. The injured RLN were repaired surgically in 43 cases, among which 39 cases’ phonation and vocal cord movement were restored completely or had their vocal cord movement recovered partly; There were only 4 cases that the phonation and vocal cord movement were not recovered. Another 5 cases that did not take any repair did not recovered naturally. Conclusion The location of most RLN injuries caused by mechanical injury during thyroid surgery is closely adjacent to the entrance of RLN into throat. Early nerve exploratory operation should be performed once the RLN is injured, and the method of repair should be decided according to concrete conditions of injury．
摘要:目的:評價II代引流型喉管(LTS II)和Proseal喉罩(PLMA)在擇期手術中應用效果。方法:檢索了Cochrane圖書館(2009年第3期)、Pubmed(1950～2009)、EMBase(1989～2009)、CNKI(1979～2009)、VIP(1989～2009)、CBM(1978～2009)中相關II代引流型喉管(LTS II)和Proseal喉罩在擇期手術中應用的隨機對照試驗(RCT),同時篩檢納入文獻的參考文獻。由2名研究者對文獻質量進行嚴格評價和資料提取,根據指標相應異質性進行描述性分析或Meta分析(RevMan 5.0)。結果:共納入3個RCT,共244例研究對象,文獻質量均為B級。3個RCT的結果顯示與PLMA相比,LTS II具有相似的首次置入成功率(P=0.45)、術畢即刻上呼吸道損傷發生率(P=1.00)、術后24 h咽痛發生率(P=0.81)、術后24 h吞咽困難發生率(P=0.12)。2個RCT的結果顯示兩組引流管置入均較容易。1個RCT的結果顯示兩組的操作者主觀評價相近(OR=1.86,95%CI 0.39～ 8.99)。氣道封閉效果由于采用方法學差異性較大,指標也不盡相同,尚不能得出準確結果。結論:LTS II在擇期手術中用于氣道管理具有較好的前景。但是現時仍不宜用于需在擇期術中進行控制通氣的病人。關于氣道封閉效果,尚需采用更合理規范的指標、更高質量的研究設計進一步研究。Abstract: Objective: To assess the efficacy of laryngeal tube suction II (LTS II) and LMAProseal (PLMA) for airway management in elective surgery. Methods:We searched Cochrane Library (2009),Pubmed (19502009)、EMBase (19892009),CNKI (19792009),VIP (19892009),CBM (19782009). The quality of the trials was assessed by two reviewers independently. RevMan 5.0 software provided by the Cochrane Collaboration was used for statistical analysis. Results:Three studies involving 244 participants were included. Same rates of fist successful attempt (P=0.45),upper airway trauma (P=1.00),sore throat (P=0.81) and dysphagia (P=0.12) were observed in LTS II and PLMA in all studies. Two studies indicated that the insertion of gastric tube was easy in both groups. The similarity of subjective maneuverability in two groups was reported in one study (OR=1.86, 95%CI 0.39 to 8.99). The correct result of effectiveness of airway seal could not be made because of various methods and measurements. Conclusion:LTS II have a good perspective in the airway management. Otherwise, it is not safe for patient required control ventilation because of lack of evidence on the effectiveness of airway seal. More RCTs of high quality need to be undertaken in the future.