Tulleners E P
Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square 19348.
J Am Vet Med Assoc. 1990 Jun 15;196(12):1971-80.
Fifty-seven Standardbred and 44 Thoroughbred racehorses and 1 Thoroughbred polo mare with primary clinical signs of exercise intolerance or respiratory tract noise or combined exercise intolerance and respiratory tract noise were referred for laser correction of epiglottic entrapment. Significantly (P less than 0.001) more Standardbred than Thoroughbred racehorses were affected, compared with the observed hospital population during the same period. At referral, 14 horses did not have evident epiglottic entrapment and were returned to exercise without development of entrapment after treatment, which consisted of 1 week of rest and administration of anti-inflammatory medication. In 88 standing horses under sedation and topical anesthesia, epiglottic entrapment was corrected transendoscopically by use of a contact neodymium:yttrium aluminum garnet laser. In these 88 horses, 98% of entrapments were persistent, 92% were thick, 97% were wide, and 45% were ulcerated. Thirty-one percent of the horses had endoscopic evidence of epiglottic hypoplasia, and 8% had deviated epiglottic axis. Complete correction was achieved in 97% of the horses, Persistent dorsal displacement of the soft palate in 1 horse and severe epiglottic hypoplasia with thick, chronic entrapping membranes in 2 horses precluded successful transendoscopic correction with the horses in standing position. Most horses were treated on an outpatient basis, and all were able to be returned to exercise after 7 to 14 days of rest and treatment with anti-inflammatory medication. Entrapment recurred in 4 horses (5%), 3 of which had hypoplastic epiglottis. Dorsal displacement of the soft palate developed after surgery in 9 horses (10%) and continued in 4 horses (5%) that had displaced soft palate before surgery. All these horses had epiglottic hypoplasia. Laser correction of epiglottic entrapment in standing horses was safe, well tolerated, and effective. Laser surgery was an alternative to conventional surgery, and eliminated the need for general anesthesia and laryngotomy. It also reduced convalescence and postoperative complications.
57匹标准赛马、44匹纯种赛马以及1匹纯种马球母马因出现运动不耐受或呼吸道杂音或运动不耐受与呼吸道杂音并存的主要临床症状，被转诊接受会厌囊肿的激光矫正治疗。与同期观察到的住院马匹数量相比，标准赛马患会厌囊肿的比例显著高于纯种赛马（P < 0.001）。转诊时，14匹马没有明显的会厌囊肿，经1周休息并给予抗炎药物治疗后，恢复训练且未再发生囊肿。在88匹处于镇静和表面麻醉状态的站立马匹中，使用接触式钕：钇铝石榴石激光经内镜矫正会厌囊肿。在这88匹马中，98%的囊肿为持续性，92%增厚，97%较宽，45%有溃疡。31%的马匹有内镜下会厌发育不全的证据，8%的马匹会厌轴偏移。97%的马匹实现了完全矫正，1匹马出现软腭持续性背侧移位，2匹马因严重会厌发育不全且伴有增厚的慢性包裹性膜，无法在站立位成功进行经内镜矫正。大多数马匹在门诊接受治疗，休息7至14天并接受抗炎药物治疗后，均能够恢复训练。4匹马（5%）复发囊肿，其中3匹马有发育不全的会厌。9匹马（10%）术后出现软腭背侧移位，4匹马（5%）术前就有软腭移位，术后持续存在。所有这些马匹都有会厌发育不全。站立位马匹会厌囊肿的激光矫正安全、耐受性良好且有效。激光手术是传统手术的替代方法，无需全身麻醉和喉切开术，还减少了恢复期和术后并发症。
