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目的探讨喉硅胶膜置人及声带黏膜缝合术在治疗喉蹼中的价值及预后转归。方法21例喉蹼患者,4例儿童,17例成人;其中既往有双侧声带手术史(声带任克水肿、声带小结、声带息肉、声带角化)8例,喉乳头状瘤手术史6例,喉部外伤史6例,先天性喉蹼1例。患者在全麻支撑喉镜下行喉蹼瘢痕松解后,15例成人行声带黏膜缝合及喉硅胶膜置人术;4例儿童及2例成人行单纯声带黏膜缝合术。结果 15例喉硅胶膜置入患者3～4周后取出支撑的硅胶膜,除1例既往曾有喉裂开史,治疗后前联合处仍残留2～3 mm 粘连带外,其余14例患者声带前联合均获得良好三角形形态,发音明显改善,无呼吸困难。6例行单纯声带黏膜缝合患者呼吸及发音得到明显改善,2例成年患者前联合处残存2～3 mm 正常黏膜,术后声带即获得很好成形效果;4例患儿术后前联合残留2～3 mm粘连。全部患者随诊6个月～3年,无瘢痕再生。结论喉硅胶膜置入及声带缝合手术治疗喉蹼,利于患者呼吸及发音功能的改善,避免颈外入路手术或气管切开及长期声门支撑,创伤小,并发症少。而声带黏膜单纯缝合手术还可以单独应用于粘连带相对较薄(小于5 mm)、黏膜相对丰富的儿童及前联合残存正常黏膜的喉蹼患者。
Objective To investigate the value and outcome of laryngeal silicone film placement and vocal cord mucosal suture in the treatment of laryngeal webs. Methods Twenty-one patients with laryngeal webs, four children and 17 adults were enrolled. Among them, there were 8 cases of bilateral vocal cord surgery (vocal edema, vocal nodules, vocal cord polyps, vocal cord keratosis), 6 cases of laryngeal papilloma , History of throat trauma in 6 cases, congenital throat web in 1 case. Patients underwent general anesthesia with laryngoscope webs under the laryngeal webs and scar release. Fifteen adults underwent vocal cord mucosal suture and laryngeal silicone film placement. Four children and two adults underwent simple vocal cord mucosal suture. Results Thirteen patients with silicone thoracic laryngeal membrane were removed after 3 to 4 weeks, and the supporting silicone membrane was removed. Except for one case, there was a history of laryngeal rupture and 2 to 3 mm adhesions remained in the anterior joint after treatment. The remaining 14 patients Vocal cord before the combination were good triangular morphology, pronounced improved significantly, no breathing difficulties. Respiratory and vocalizations were significantly improved in 6 patients with simple vocal cord mucosal suture, and 2 to 3 mm of normal mucosa remained in the 2 patients with anterior commissure, and the vocal cords had a good forming effect after operation. In 4 patients, preoperative combined residue 2 ~ 3 mm adhesion. All patients were followed up for 6 months to 3 years, without scar regeneration. Conclusion Laryngeal silicone film placement and vocal cord suture treatment of laryngeal webbed, which will help patients with respiratory and phonological improvement, to avoid the external carotid surgery or tracheotomy and long-term glottis support, trauma, fewer complications. The simple operation of vocal cord mucosal suturing can also be applied alone to the adhesion zone is relatively thin (less than 5 mm), the mucous membrane is relatively rich in children and the former combined remnants of normal mucosa throat web patients.