CAJ | 학술논문

目的观察支撑喉镜下环咽肌形态.方法采用普通支撑喉镜系统,观察因咽喉部疾病需做喉显微外科手术且无吞咽困难主诉的患者100例.气管插管全身麻醉,同时使用肌肉松弛药物,喉镜由环后插入,将喉向前抬起,暴露环咽肌.图像采集系统记录环咽肌图像.结果 94例患者环咽肌得到良好暴露,6例因颈椎僵硬或肥胖未能暴露.观察发现支撑喉镜下环咽肌形态分为3型:即下咽后壁无明显隆起,可见整个食管腔的平坦型,下咽后壁黏膜槛突向前方,可见部分食管腔的半槛型,以及下咽后壁凸起接近食管入口前壁,食管窥不见的全槛型.各型例数分别是平坦型14例(14.9％),半槛型59例(62.8％),全槛型21例(22.3％).成年组90例和≥65岁老年组10例患者环咽肌类型差异经卡方检验差异无统计学意义(x2=1.224,P=0.747).反流有关组和反流无关组间环咽肌类型差异也无统计学意义(x2=5.252,P=0.072).结论支撑喉镜能够很好地暴露大多数患者的环咽肌,为开展内镜下环咽肌切断术提供了实践基础.
목적 관찰지탱후경하배인기형태.방법 채용보통지탱후경계통,관찰인인후부질병수주후현미외과수술차무탄인곤난주소적환자100례.기관삽관전신마취,동시사용기육송이약물,후경유배후삽입,장후향전태기,폭로배인기.도상채집계통기록배인기도상.결과 94례환자배인기득도량호폭로,6례인경추강경혹비반미능폭로.관찰발현지탱후경하배인기형태분위3형:즉하인후벽무명현륭기,가견정개식관강적평탄형,하인후벽점막함돌향전방,가견부분식관강적반함형,이급하인후벽철기접근식관입구전벽,식관규불견적전함형.각형례수분별시평탄형14례(14.9％),반함형59례(62.8％),전함형21례(22.3％).성년조90례화≥65세노년조10례환자배인기류형차이경잡방검험차이무통계학의의(x2=1.224,P=0.747).반류유관조화반류무관조간배인기류형차이야무통계학의의(x2=5.252,P=0.072).결론 지탱후경능구흔호지폭로대다수환자적배인기,위개전내경하배인기절단술제공료실천기출.
Objective To observe the morphologic features of cricopharyngeal muscle(CPM) under suspension laryngeal endoscope.Methods This prospective study was conducted on a series of 100consecutive patients who undergone endoscopic microlaryngeal surgery with intubation general anesthesia.The suspension laryngoscope was introduced down to postcricoid area approaching esophageal inlet.By lifting the larynx with the laryngoscope,the mucosa-covered cricopharyngeal muscle was easily identified as the mound of tissue just at the posterior pharyngeal wall.The image of cricopharyngeal muscle under the laryngoscope was saved.Results In 94 out of 100 patients,CPM could be visualized with laryngoscope.In the other 6 patients,both CPM and glottic could not be exposed because of cervical vertebra stiffness and obesity.According to the image of CPM under the laryngoscope,the shape of the CPM was divided into three types.It was named for flat type in which there was no mound of tissue visible at the posterior pharyngeal wall and esophageal cavity could be visible completely,semi-bar type in which there was a bar at the posterior pharyngeal wall and partial esophageal cavity could be visible and full-bar type in which the bar contact esophageal anterior wall and esophageal cavity could not be visible.There were 14(14.9％) patients as fiat type,59(62.8％) as semi-bar type and 21(22.3％) as full-bar type.No significant difference was found between adults group and the aged (≥ 65 years old) group (x2 =1.224,P =0.747) and reflux associated group and non-reflux associated group respectively (x2 =5.252,P =0.072).Conclusions The CPM could be well exposed in most of the patients with suspension laryngeal endoscope.It provides anatomy basis for endoscopic cricopharyngeal myotomy.