聲帶結節之顯微手術：下壓法

A Pressing Technique for Microsurgical Excision of Vocal Nodules

李家和(Ka-Wo Lee)

《中華民國耳鼻喉科醫學會雜誌》 32卷2期 (1997/04) Pp. 125-130

https://doi.org/10.6286/1997.32.2.125

摘要

聲帶結節之處置，一般先給予語言治療及音聲衛生敎育，治療結果不理想或角質化明顯之結節，可施行手術切除。此類扁平型結節之傳統手術方法，先以顯微鉗子夾住結節再用顯微刀或剪刀切除，其缺點是：1）病灶愈小愈不易以鉗子固定；2）若以鉗子夾住再切除則容易切得過深；3）雙手各持器械操作不易穩定；4）同時使用兩種手術器械容易顯響視野。
為改進上述缺點，著者從3年前採用新技巧－下壓法（pressing technique），以齊藤氐向上模開彎剪及銳匙狀鉗子，對198例聲帶結節病例施行喉顯微手術，其優點為：1）可精確切除細微病灶；2）切除深度及範圍更易控制；3）使用單種手術器械視野清楚；4）右手操作時左手可輔助而更穩定。結果顯示術後聲嘶之治癒率達94.9%，隨技巧之日漸成熟，手術所需時間愈短。對於聲帶結節及其他扁平或細微、表淺性聲帶病灶，下壓法是一種較易掌握且精確之選擇。

關鍵字

喉顯微手術 ； 音聲手術 ； 喉

並列摘要

Voice therapy has long been the main treatment of choice for patients with vocal nodules. Surgical excision is usually indi-cated in those who fail in medical treat-ment, those having a larger lesions for a long time or exhibiting obvious keratosis.
Certain difficulties may be encoun-tered during microsurgery of these sessile lesions, as they used to be , by the conventional “traction and excision” method;
1)the smaller the lesion, the more difficult for the surgeon to grasp with the microforceps
2)over-excision is always possible once the sessile nodules are grasped with the instrument
3)simultaneous manipulation of two surgical instruments is relatively difficult
4)obscuration of the operation field by the two long-shafted instruments may be obvious
An improved “Pressing Technique” has been developed for microlaryngosopic exci-sion of the sessile vocal nodules. This method employs two sets of horizontal-opened, curved scissors and cupped micro-forceps (Saito’s type). The main advan-tages of this technique are; well controlled, precise and delicate excision of the sessile lesions can be done more easily with less chance of over-excision, and a wider and clearer field of operation can be achieved during the procedure. The surgical tech-nique and the results were presented.

並列關鍵字

laryngomicrosurgery ； phonosurgery ； larynx