下咽黏膜下异物3例临床分析

Clinical analysis of foreign bodies in the hypopharyngeal submucosal tissues: a report of 3 cases

摘要:

目的探讨包埋型下咽黏膜下异物的诊治方式，以期减少漏诊、选取合适手术方式取出异物。方法3例包埋型下咽黏膜下异物患者通过询问病史、影像学检查、电子鼻咽喉镜检查而确诊，在支撑喉镜下使用显微喉镜钳、CO2激光辅助治疗等方式切开黏膜组织取出异物，并观察预后情况。结果3例患者均成功取出异物，术中出血少、创伤小，术后给予禁食水、补液、抗感染等治疗，患者恢复快，均治愈出院。结论包埋型异物较为少见，详细了解异物进入病史及依据CT影像学等辅助检查准确定位制定手术方案，咽后间隙、黏膜下及其间隙的异物可考虑行支撑喉镜下异物取出术，异物在颈动脉间隙、甲状腺等处或毗邻重要血管、器官时可考虑行颈部开放手术。通过准确定位增加该病治疗成功率。

Abstract:

ObjectiveTo investigate the diagnosis and treatment of foreign bodies embedded in the hypopharyngeal submucosal tissues, it will reduce the misdiagnosis and select appropriate surgical methods to remove the foreign bodies.MethodsThree cases of foreign bodies embedded in the hypopharyngeal submucosal tissues were diagnosed by medical history, imaging examination and video rhinolaryngoscope. The microscopic laryngoscope clamp and CO2 laser were used to cut the submucosal tissues and remove the embedded foreign bodies through the selfretaining laryngoscope, and the prognosis of patients was observed.ResultsThe foreign bodies were removed successfully in all 3 patients. During the operation, the patients was less bleeding, the minor trauma and the rapider recovery. The patients were given the prohibition of food and water, fluid replacement, antiinfection and other treatments after the operation. All patients were cured and discharged from hospital.ConclusionThe type of the embedded foreign bodies is relatively rare. The foreign bodies can be removed under the support laryngoscope and preparation of the operation according to the detailed history of foreign bodies and the accurate positioning of the auxiliary examinations such as CT imaging.For foreign bodies in the space of posterior pharyngeal and submucosal tissues, the removal of foreign bodies under support laryngoscope may be considered. When the foreign bodies are in the carotid artery space, thyroid or near the important structures(blood vessels and organs), the use of open neck surgery may be considered. Accurate location increases the success rate of diagnosis and treatment in the disease.