本文選題：激光手術(shù) + 前連合�。� 參考：《寧夏醫(yī)科大學(xué)》2011年碩士論文

【摘要】：目的探討激光手術(shù)治療喉部前連合疾病時(shí),既可以切除病變,同時(shí)又可以避免術(shù)后前連合粘連、喉狹窄及呼吸困難的較理想手術(shù)方法。 方法將12只實(shí)驗(yàn)犬隨機(jī)分成4組,每組3只。A組分兩次手術(shù)切除實(shí)驗(yàn)犬前連合,間隔時(shí)間為2周;B組一次性切除實(shí)驗(yàn)犬前連合,同時(shí)以硅膠膜片縫合固定于前連合處,2周后拆除硅膠膜;C組一次性切除前連合,術(shù)后前連合創(chuàng)面蘸涂絲裂霉素-C(MMC)按壓5分鐘;D組一次性切除前連合,術(shù)后創(chuàng)面不做其它處理。4周后電子喉鏡下觀察各組創(chuàng)面恢復(fù)情況,并且術(shù)前、術(shù)后分別測(cè)量各組實(shí)驗(yàn)犬聲帶長(zhǎng)度及聲門面積,比較其變化;各組前連合標(biāo)本制作病理切片,常規(guī)HE染色及VG染色比較其組織學(xué)差異。 結(jié)果全部實(shí)驗(yàn)犬均在激光下順利按計(jì)劃完成手術(shù),術(shù)后4周創(chuàng)面觀察:A組創(chuàng)面有新生粘膜覆蓋,炎癥反應(yīng)輕,前連合無(wú)明顯粘連;B組創(chuàng)面粘膜覆蓋,局部見暗紅色慢性炎癥改變,前連合輕度粘連;C組創(chuàng)面粘膜覆蓋,術(shù)區(qū)水腫,前連合中度粘連;D組術(shù)區(qū)腫脹,前連合明顯粘連。A、B、C、D四組犬吠均有不同程度的聲嘶,A組最輕,B、C組次之,D組最重。4組實(shí)驗(yàn)犬聲帶長(zhǎng)度資料分析:組內(nèi)比較采用配對(duì)t檢驗(yàn),A、B、C三組P0.05,無(wú)統(tǒng)計(jì)學(xué)意義,說明聲帶長(zhǎng)度術(shù)后較術(shù)前縮短不明顯,D組P0.05,說明聲帶長(zhǎng)度術(shù)后較術(shù)前明顯縮短;組間比較采用重復(fù)測(cè)量方差分析(P0.05)說明不同處理組間聲帶長(zhǎng)度變化有差異。經(jīng)兩兩比較,認(rèn)為A組效果最好,B、C組次之,兩者之間無(wú)明顯差異。4組實(shí)驗(yàn)犬聲門面積資料分析:組內(nèi)比較采用配對(duì)t檢驗(yàn),A、B兩組P0.05,無(wú)統(tǒng)計(jì)學(xué)意義,說明聲門面積術(shù)前術(shù)后變化不明顯,C、D兩組P0.05,說明聲門面積術(shù)后較術(shù)前明顯縮小;組間比較采用重復(fù)測(cè)量方差分析(P0.05),尚不能認(rèn)為四組之間聲門面積變化有明顯差異。病理切片觀察,常規(guī)HE染色顯示:A組組織水腫,粘膜下層有裂隙狀血管,少量中性粒細(xì)胞及淋巴細(xì)胞浸潤(rùn);B組、C組間質(zhì)內(nèi)透明變性比較明顯,可見中性粒細(xì)胞及淋巴細(xì)胞浸潤(rùn),伴有新生毛細(xì)血管增生;D組見粘膜下有較多中性粒細(xì)胞及淋巴細(xì)胞浸潤(rùn),伴多量小血管增生。VG染色顯示:損傷后的組織中含有大量的膠原纖維,其中A組最少,B組中等,C組含量較多,D組最多。 結(jié)論激光手術(shù)切除實(shí)驗(yàn)犬前連合,通過4種不同的術(shù)式比較,A組防止術(shù)后粘連效果最好,B組、C組次之,D組最差。本實(shí)驗(yàn)結(jié)果對(duì)臨床中應(yīng)用激光治療侵犯至前連合病變的術(shù)式選擇有一定的參考價(jià)值。
[Abstract]:Objective to explore the ideal method of laser surgery for the treatment of anterior laryngeal ligation disease, which can not only remove the lesion, but also avoid postoperative anterior conjunctive adhesion, laryngeal stenosis and dyspnea. Methods Twelve experimental dogs were randomly divided into 4 groups, 3 dogs in each group were divided into two groups: the anterior conjunctions of experimental dogs were resected twice, the interval time was 2 weeks and the interval was 2 weeks, group B had a one-off excision of the anterior conjunctions of experimental dogs. At the same time, the silicone film was sutured and fixed at the anterior junction for 2 weeks. After removing the silicone film, group C had a single resection of the anterior conjunct, and the wound of the anterior conjunctive wound was dipped with mitomycin-Con MMC. after operation, the group D was pressed for 5 minutes. The wound recovery was observed under electronic laryngoscope after 4 weeks without other treatment. Before and after operation, the length of vocal cord and glottic area of experimental dogs in each group were measured, and the changes of glottic area were compared. Histological differences were compared between routine HE staining and VG staining. Results all the dogs were successfully operated according to the plan under laser irradiation. The wounds of group A were covered with new mucosa and the inflammatory reaction was light at 4 weeks after operation. There was no obvious adhesion of anterior ligation and no obvious adhesion of mucous membrane in group B. Local changes of dark red chronic inflammation were observed in group C with mild anterior synechia, mucosal coverage, edema in operation area and swelling in group D with moderate anterior conjunctions. The data of vocal cord length in group A and group C, followed by group D, were analyzed. The data of vocal cord length in group A were compared with that in group C (pairing t test) (P 0.05), and there was no significant difference between group A and group C (P > 0.05). The results showed that the length of vocal cord after operation was not significantly shorter than that before operation in group D, and the length of vocal cord after operation was significantly shorter than that before operation, and the differences in length of vocal cord between groups by repeated measurement of variance analysis of variance (P0.05) indicated that there were differences in the length of vocal cord among different treatment groups. It was concluded that group A had the best effect in group C, and there was no significant difference between the two groups. 4. Analysis of glottic area data of experimental dogs in group 4: there was no significant difference between group A and group B by paired t test (P0.05), and there was no significant difference between group A and group B (P < 0.05). The results showed that the glottic area was not significantly changed before and after operation in two groups, indicating that the glottic area was significantly reduced after operation, and that there was no significant difference in glottic area between the four groups by repeated measurement of variance analysis of variance (P0.05). Histopathological observation showed that tissue edema and fissure vessels were found in the submucosa of group A with routine HE staining. A small amount of neutrophils and lymphocytes infiltrated the interstitial cells of group B and the interstitial hyaline degeneration in group B was more obvious, and neutrophil and lymphocyte infiltration were observed in group C, and neutrophil and lymphocyte infiltration were observed. In group D, neutrophilic granulocyte and lymphocyte infiltration were found in the submucous membrane, and VG staining showed that there was a large number of collagen fibers in the injured tissue. Among them, group A, B, group B, group C were more than group D, the content was the most. Conclusion after laser resection of experimental dogs, the effect of preventing postoperative adhesion in group A is the best and that in group C is the worst, and that in group D is the worst. The results of this study have some reference value for clinical application of laser in the treatment of anterior ligation lesions.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類號(hào)】：R767

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