Zeitels Steven M, Burns James A, Dailey Seth H
Department of Otology and Laryngology, Harvard Medical School, and Division of Laryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts 02114, USA.
Ann Otol Rhinol Laryngol. 2004 Jan;113(1):16-22. doi: 10.1177/000348940411300104.
Every critical advancement in direct laryngoscopic surgical technique has enhanced its precision. Among the most notable was Killian's seminal description of suspension laryngoscopy 90 years ago, which allowed for bimanual direct laryngoscopic surgery. Because of the technical difficulties encountered while performing suspension laryngoscopy, Brünings and Seiffert designed fulcrum laryngoscope holder-stabilizers for spatula laryngoscopes from Killian's original instrument design. Their devices, which were easier to use and better tolerated by patients, were supported from the laryngeal cartilage framework or chest wall. Laryngoscope holder-stabilizers were retrofitted to tubular laryngoscope specula in the 1940s and 1950s, whereupon they became very popular. Suspension laryngoscopy should have become more common subsequent to the introduction of general endotracheal anesthesia with paralysis in the 1960s. However, laryngoscope holder-stabilizers were entrenched as the device preferred by most, and they remain so today. This entrenchment occurred despite the fact that suspension laryngoscopy allows for positioning a larger examining speculum, which in turn allows for enhanced exposure and endolaryngeal procedural precision. The applied vector forces on the mandible, maxilla, oral cavity, pharynx, and larynx associated with suspension laryngoscopy are preferable to those associated with holder-stabilizers. A prospective assessment of 120 cases revealed effective use of suspension laryngoscopy in all. We believe that only a minority of surgeons has actually seen true suspension laryngoscopy and that its merits are worthy of reexamination.
直接喉镜手术技术的每一项关键进展都提高了其精确性。其中最显著的是90年前基利安对悬吊喉镜的开创性描述，它使得双手直接喉镜手术成为可能。由于在进行悬吊喉镜检查时遇到技术困难，布吕宁斯和赛费特根据基利安的原始器械设计，为直接喉镜设计了支点喉镜固定稳定器。他们的器械使用起来更方便，患者耐受性更好，由喉软骨框架或胸壁支撑。20世纪40年代和50年代，喉镜固定稳定器被改装到管状喉镜窥镜上，随即变得非常流行。在20世纪60年代引入全身气管内麻醉并使用肌肉松弛剂后，悬吊喉镜检查本应变得更普遍。然而，喉镜固定稳定器却成为了大多数人首选的器械，至今仍是如此。尽管悬吊喉镜检查能够放置更大的检查窥镜，进而实现更好的暴露和喉内操作精确性，但这种偏好仍然存在。与悬吊喉镜检查相关的作用在下颌骨、上颌骨、口腔、咽和喉部的矢量力比与固定稳定器相关的力更可取。对120例病例的前瞻性评估显示，悬吊喉镜检查在所有病例中都得到了有效应用。我们认为，实际上只有少数外科医生真正见过真正的悬吊喉镜检查，其优点值得重新审视。
