Tulleners E P
Department of Clinical Studies, School of Veterinary Medicine, Kennett Square, PA 19348.
J Am Vet Med Assoc. 1991 May 1;198(9):1631-5.
Three basic techniques (and one modified technique) were developed, allowing successful excision of subepiglottic cysts in 10 horses (5 Standardbreds, 4 Thoroughbreds, and 1 Quarter Horse; mean age, 3.5 years) via peroral approach. This approach eliminated the need for laryngotomy or pharyngotomy and reduced postoperative care. None of the cysts redeveloped. Clinical signs of disease before surgery included respiratory noise, exercise intolerance, coughing, and dysphagia and were eliminated in all horses except one that raced successfully, but in which some respiratory noise was detected. Peroral subepiglottic cyst excision was performed on anesthetized horses that were positioned in lateral recumbency and intubated via the nares and trachea. General anesthesia allowed careful intraoral palpation and endoscopic visualization of the oropharynx on a television monitor. Custom-designed instruments, including a guide tube, cyst snare, and long grasping forceps, facilitated either laser or snare, or laser and snare cyst excision. Hemorrhage was negligible in all horses. Initial attempts to develop a technique to submucosally excise subepiglottic cysts through a transnasal transendoscopic approach in conscious horses, using a contact neodymium:yttrium aluminum garnet laser, were unsuccessful. In each of 3 horses, the cyst was inadvertently penetrated before it could be excised, causing it to collapse and disappear beneath the soft palate. Postoperative complications were excessive subepiglottic swelling after laser excision (n = 1 horse), which resolved completely in response to anti-inflammatory treatment, and subepiglottic cicatrix formation after snare excision (n = 1 horse), which required surgical excision of the cicatrix.
研究开发了三种基本技术（以及一种改良技术），通过经口途径成功切除了10匹马（5匹标准赛马、4匹纯种马和1匹夸特马；平均年龄3.5岁）的会厌下囊肿。这种方法无需进行喉切开术或咽切开术，并减少了术后护理。所有囊肿均未复发。术前疾病的临床症状包括呼吸杂音、运动不耐受、咳嗽和吞咽困难，除一匹成功参赛但仍检测到一些呼吸杂音的马外，所有马匹的这些症状均消失。经口会厌下囊肿切除术在侧卧并经鼻孔和气管插管的麻醉马匹上进行。全身麻醉便于在电视监视器上仔细进行口内触诊和口咽内镜检查。定制设计的器械，包括引导管、囊肿圈套器和长钳，有助于采用激光或圈套器，或激光和圈套器联合切除囊肿。所有马匹的出血都可忽略不计。最初尝试开发一种在清醒马匹中通过经鼻经内镜途径黏膜下切除会厌下囊肿的技术，使用接触式钕：钇铝石榴石激光，但未成功。在3匹马中，每匹马的囊肿在切除前都意外被穿透，导致囊肿塌陷并消失在软腭下方。术后并发症包括激光切除后会厌下过度肿胀（1匹马），经抗炎治疗后完全消退；圈套器切除后会厌下瘢痕形成（1匹马），需要手术切除瘢痕。
