电子喉镜在耳鼻喉科疾病诊治中的应用探讨
作者：姜俊芝，王静，郭淑霞，刘飞。
【关键词】 耳鼻喉科。
Video laryngoscopy for diagnosis and treatment of diseases in otolaryngolory。
［Abstract］ Objective To explore the experience with video laryngoscope used for the diagnosis and surgical treatment of otolaryngolory diseases.Methods FUJINON ER—270T mode of video laryngoscope,made in Japan,was used in clinic for these goals.Diagnostic using was carried out among 968 cases with otolaryngolory disorders,with laryngeal used in 678 cases,nosopharyngeal used in 236 cases,and auditory canal used in 54 cases,and therapeutic using was performed among 132 cases with vocal cord polyp or nodules of vocal cords and so on by surgical treatment. Results All the 968 cases with diagnostic using were successfully examined under video laryngoscope,with correct diagnosis set up for them.Surgical procedures were also performed successfully under video laryngosscope among 91 cases with polyp of vocal cord,41 cases with vocal cord nodules,3 cases with cysts of vocal cord,and 28 cases with foreign body in hypopharynx.118 cases with epistaxis were cured.Conclusion Video hryngoscope should be very helpful for diagnoses and treatment of otolaryngolory diseases in clinic.It can reach a higher rate of confirmed diagnosis for laryngeal lesions.
［Key words］ video laryngoscope;otolaryngolory;diagnosis;treatment。
电子喉镜已被广泛应用于耳鼻喉科，尤其在门诊，已经成为耳鼻喉科疾病诊断与治疗的新手段，笔者自2006年1～12月应用电子喉镜对968例有耳鼻喉科症状的患者进行诊治，现报告如下。
1 资料与方法。
1.1 一般资料 耳鼻咽喉部疾病968例，男479例，女489例，年龄11～82岁，平均46.7岁，其中60岁以上的162例，全部患者均有耳鼻喉科不适症状。
1.2 仪器设备 采用日本FUJINON ER—270T型电子喉镜，连接JVC彩色监视器，配电脑图文工作站，并配活检钳、息肉钳和异物钳等。
1.3 检查和治疗方法 除耳科检查者外，其余均采用平卧位，肩下垫小枕使头稍后仰，操作人员立于患者头顶，用1%地卡因溶液和1%麻黄素滴鼻剂喷洒双鼻腔2～3次，每次间隔3～5 min，麻醉并收缩鼻黏膜，喉部检查用喉头喷雾器将1%地卡因做下咽喷雾3次，麻醉药量一般不超过6 ml，如需做喉部手术和治疗，则加环甲膜穿刺，注入1%地卡因1～2 ml，然后令患者咳嗽并吐出，使喉部黏膜被充分麻醉，术者右手持镜体前端，左手尽可能固定镜管，大拇指控制镜头角度，从一侧前鼻孔插入（个别患者经鼻腔插镜有困难，也可经口进入），沿下鼻道或中鼻道至鼻咽部，对上述部位进行详细观察，如需对鼻咽部病变进行取材，可用鼻咽活检钳在电子喉镜引导下，经口挑起软腭至鼻咽钳取大块病灶组织；再向下可观察软腭背面、咽后壁、舌根、会厌及喉部情况；取异物可用异物钳经电子喉镜侧孔导入，使之与病变组织相距1～2 cm，助手使钳头伸出管口0.5～1 cm左右对异物进行钳取；声带息肉、小结和囊肿等治疗可通过电子喉镜侧孔放入息肉钳，然后切除病变组织。检查耳部时要使患者侧卧位，患耳向上，操作者持镜方式同前，把镜体前端置入外耳道逐渐向内深入观察外耳道壁和鼓膜情况，此项检查用于司法鉴定鼓膜有无穿孔可信度较高。对鼻衄患者，在充分表麻下可配合微波等进行出血部位的准确止血。
1.4 图像资料留取及组织送检 检查时随时定格图像保存于电脑，打印彩色报告以备随访对照，手术切除组织全部送病理检查，术后严格复查随访。