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題名 | Microfibrillar Collagen for Hemostasis in Laryngomicrosurgery of Hypopharyngeal Hemangioma=使用顯微鏡纖維膠原於下咽部血管瘤喉顯微手術出血 |
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作者 | 李詩偉; 方端仁; 徐景雯; 李學禹; | 書刊名 | 長庚醫學 |
卷期 | 26:1 2003.01[民92.01] |
頁次 | 頁65-69 |
分類號 | 416.89 |
關鍵詞 | 顯微纖維膠原; 下咽部血管瘤; 釹雅各雷射; Microfibrillar collagen (Avitene); Hypopharyngeal hemangioma; Nd:YAG laser; |
語文 | 英文(English) |
中文摘要 | 下咽部血管瘤為少見之良性血管瘤,臨床症狀為吞嚥不適、喉部異物感、反覆流血,甚至呼吸道阻塞等等。治療上以緩解患者症狀,以及控制腫瘤大小為原則。雷射對於此血管性腫瘤的治療效果良好。 雷射手術曘常見的併發症為術中出血;對於手術時發生流血的情形,常使狦的止血方式包括壓迫傷口、電燒、血管綁紮、或是縫合等等。但是在某些情況下,例如較廣的滲血表面,或是在器械不易操作的侷限空間時,可以考慮使用局部止血物質。Avitene為純化之生物膠質,具有不溶於水的特性,外表呈乾躁,稀鬆的財末狀,使用時可將整圪Avitene塞在流血處,或是利用注射空針施打入患處止血。Avitene提供了血小板吸附之介面以利血塊形成,達到止血目的。Avitene在受潮之後,會去活化而漸漸自行分解消常。本院經歷一31歲男性,主訴咽喉異物感六個月。理學檢查發現於右下咽部有紫紅色表面平滑之腫塊,電腦斷層掃描檢查顯示於右側下咽處之軟組織有輕微顯影,並且延伸至右側之側咽空間。遂安排病患於手術房中以喉內視貸配合釹雅各雷射(Nd-Yag laser)切除腫瘤,手術其間傷口出現大量滲血(oozing);在嘗試以壓迫傷口、電燒等方法皆無法止血,遂利用顯微器械,將Avitene填塞至傷口出血處,而後成功止血;總計失血量100cc。病理報告為下咽部血管瘤。術後追蹤傷口復原情況良好,沒有再次出血情形,病灶亦得到控制。藉由Avitene的使用為後盾,面對雷射治療導致之大量滲血,可以有效地控制出血,以便完成手術。 |
英文摘要 | Hypopharynegeal hemanagiomas are uncommon neoplasms that can cuase dysphagia, recurrent bleeding, and airway obstruction. These lesions are a therapeutic challenge, and surgical resection is the mainstay of therapy. The goal of therapy is directed at control of the tumor and relief of symptoms rather than total readication of the lesion. Laser therapy is a very useful adjunct in the management of these vascular neoplasms. The neodymium: yttrium-aluminum-garnet laser (Nd: YAG laser) functions at a wavelength that provides deep thermal coagulation. This allows its use for these vascular lesions. With laser surgery, hemorrhage is the most frequent and dangerous complication, and its control is extremely important. Ligation and suture remain the tradiotnal methods of hemostasis in most surgical situations. However, on certain occasions problems arise, particularly with large oozing surfaces or when surgical access is poor. Topical hemostatic agents are widely used in a variety of surgical procedures to successfully solve such problems. Micorfibrillar collagen (Avitene) is one of the absorbable, topical, hemostatic agents, and is use effectively to control bleeding in may surgical situation.s since we began to use microfibrillar collagen (AviteneTM, MedchemProduct, Inc,. Woburn, MA01801) to stop the massive oozing of the laser-induced surgical wound, no episodes of bleeding had ever occurred. It si concluded tha Avitene is a effective agent for maintaining hemostastis in may surgical procedures, and we consider it a good remedy for management of laser-induced bleeding complications. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。