低温等离子术后假膜脱落的临床讨论

田天捷; 周意; 刘忠; 刘军

doi:10.13201/j.issn.1001-1781.2014.13.019

低温等离子术后假膜脱落的临床讨论

- 恩施土家族苗族自治州中心医院耳鼻咽喉-头颈外科(湖北恩施, 445000)

详细信息

通讯作者: 周意,E-mail:zy196731@sina.com

中图分类号: R764

收稿日期: 2013-11-15

Reflection on the exfoliation of the tunic albuginea after the low-temperature plasma operation

- Department of Otolaryngology-Head and Neck Surgery, the Central Hospital of Enshi Tujia and Miao Autonomus Prefecture, Enshi, 445000, China

More Information

Corresponding author: ZHOU Yi, E-mail: zy196731@sina.com

Received Date: 15 November 2013

摘要

摘要: 目的：观察低温等离子术后假膜脱落情况，讨论由此可能带来的一些潜在问题。方法：以2012-11-2013-06期间行低温等离子手术的481例患者为研究对象，其中行扁桃体切除术116例，腺样体消融术98例，下鼻甲消融术255例，会厌囊肿切除术8例，喉部新生物切除术4例。重点观察术后假膜出现情况、脱落时间、脱落后伤口情况以及有无并发症发生。结果：扁桃体切除术后假膜脱落时间在2周左右，并发出血3例，其中1例与进食不当有关。腺样体消融术后2~3周假膜基本脱落，未出现后鼻孔狭窄及咽腔粘连等。会厌囊肿切除术后4周左右假膜脱落，并发出血1例。下鼻甲消融术后3~4周假膜脱落，1例患者在术后2个月并发大出血。1例左喉室神经鞘瘤患者术后4个月假膜才完全脱落，术区又长出新生物；1例左声带重度不典型增生伴原位癌患者术后4个月假膜还未完全脱落，术区亦可见新生物，术后9个月术区创面平整光滑，愈合好；1例左声门下上皮样血管内皮瘤患者术后第8天假膜完全脱落，随访至术后6个月未见复发；1例左侧杓会厌襞囊肿患者术后失访。前3例患者均未出现出血、内源性气管异物等并发症。结论：低温等离子手术具有明显优势，但术后假膜脱落带来的潜在问题值得引起足够重视，特别是低温等离子喉部新生物术后假膜脱落时间长短不一，与文献报道不完全一致，可能与其作用于周围组织的时间有关。
- 等离子射频消融术 /
- 手术 /
- 假膜
Abstract: Objective: Todiscuss the potential problems caused by the exfoliation of the tunic albuginea after the low-temperature plasma operation. Method: To observe the occurrence of the tunic albuginea, exfolliating time,wound healing and its complications by following the patients received the low-temperature plasma operation from November in 2012 through June in 2013 (including 116 cases of tonsillectomy,98 cases of adenoidectomy, 255 cases of the ablation of the inferior turbinate,8 cases of the ablation of the cyst of epiglottis, and 4 cases of the ablation of the tumor of larynx) together with reviewing the relevant literatures.Result: The tunic albuginea exfolliated about two weeks after tonsillectomy, bleeding was found in 3 cases, one of which was related with inappropriate eating; the exfoliation about two or three weeks after adenoidectomy, without the occurrence of the narrow nostril and pharyngeal cavity adhesion; about four weeks after the ablation of the cyst of epiglottis, bleeding was found in 1 case; about three or four weeks after the ablation of the inferior turbinate, massive bleeding was found in one case after two months; and the ablation of the tumor of larynx, one with severe atypical hyperplasia and carcinoma in situ, the tunic albuginea did not completely exfoliate four moths after the surgery and new creatures could be found,the wound looked smooth and healed well nine moths after the surgery.The full exfoliation occur four months after the surgery for one with the neurilemmoma in the left laryngeal ventricle and the new creatures could also be found. It exfoliated eighth days after the surgry for one patient with left subglottic epithelioid heman-gio endothelioma and it did not recur even six months after the surgery. Another one with the cyst of the left plica aryepiglottica failed to be followed. The first three patients did not suffer from such complications as bleeding,endogenous in trachea, etc.Conclusion: Low-temperature plasma surgery has obvious advantages, but the potential problems caused by the surgery need to be taken in accounted, especially the exfoliating time of the tunia albuginea is different after the ablation of the tumor of larynx, which is inconsistent with what the literatures reported, it could partially due to the action time of low-temperature plasma surgery with surrounding tissues.
- low-temperature plasma operation /
- surgery /
- tunic albuginea

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