經口內視鏡腺樣體切除術

Transoral Endoscopic Adenoidectomy

林嘉德(China-Der Lin) ； 許權振(Chuan-Jen Hsu) ； 蔡銘修(Ming-Hsui Tsai) ； 李憲彥(Shiann-Yann Lee)

《中華民國耳鼻喉科醫學雜誌》 34卷2期 (1999/03) Pp. 105-108

https://doi.org/10.6286/1999.34.2.105

摘要

背景：傳統腺樣體切除多用手指感覺或以間接鼻咽鏡檢輔助手術進行，缺乏適當指引而容易傷及耳咽管並殘留腺樣體組織。近10年來內視鏡的進步，有人開始應用內視鏡指引腺樣體切除，然而多是自體進入，但在狹窄的鼻道中操作有時相當困難；本文提出經口內視鏡指引腺樣體切除，並討論其優點。
方法：收集1997年3月到1998年7月間接受腺樣體切除術患者共15名，男性12名，女性3名；年齡自2歲10月到8歲，平均年齡4歲8月；4名嚴重鼻道阻塞，8名持續中耳積液，3名同時存在鼻道阻塞及中耳積液。手術採插管全身麻醉，以30°或70°鼻竇內視鏡經口深入口咽部就可看到鼻咽全貌，然後在目視監測下以腺樣體刮匙完成腺樣體切除；最後在經口內視鏡的監視下摘除其餘殘留腺樣體淋巴組織及止血。
結果：併行之手術：10名同時置入中耳通氣管，2名同時接受腭扁桃切除，1名同時置入中耳通氣管及腭扁桃切除。所有腺樣體切除都可在15分鐘內完成，術中及術後都無重大併發症，術後患者鼻部不適症狀多在兩天之內緩解。
結論：相對於傳統間接接鏡檢或經鼻內視鏡指引，在寬大的口咽部中以經口內視鏡指引腺樣體切除，手術視野良好，可以在不受干擾及不虞傷害耳咽管的情況下達到完全腺樣體摘除，也可以精確地控制術中或術後出血，因此是一簡便有效的手術方法。

關鍵字

腺樣體切除術 ； 內視鏡 ； 經口

並列摘要

Background: A conventional adenoidectomy is performed with an adenoid curette or adenotome under finger palpation or indirect mirror visualization. Transoral endoscopic adenoidectomy can offer excellent visualization of the nasopharynx without interrupting the surgical procedure. This paper presents our experience of adenoidectomy under transoral endoscopic guidance.
Methods: In the past sixteen months, transoral endoscopic adenoidectomy was performed on 15 children with adenoid hyperplasia. Under general anesthesia and after retraction of the soft palate, the endoscope was inserted into the oropharynx to obtain a panoramic view of the nasopharynx. An adenoid curette was then applied to the adenoids under simultaneous direct visualization with the transoral endoscope. The adenoids were debulked without damage to the torus tubarius. Under transoral endoscopic guidance, the residual anenoids were removed with transoral or transnasal forceps. Final hemostasis could also be achieved via direct endoscopic visualization.
Results: An adenoidectomy can be completed in 15 minutes in this method. There were no major perioperative complications such as intractable nasopharyngeal hemorrhage. Minor nasal complaints such as nasal obstruction subsided in two days.
Conclusions: An adenoidectomy should be performed quickly under good direct vision with minimal blood loss and no complications. We recommended the use of a transoral endoscope. It provides good exposure of the nasopharynx, facilitates radical adenoidectomy without damage to the torus tubarius, and aids in hemostasis under direct vision.

並列關鍵字

adenoidectomy ； endoscope ； transoral