双侧声带麻痹的外科治疗

Surgical Treatment for the Bilateral Abductor Paralysis

总结２７例双侧声带外展麻痹患者手术治疗的效果。全部病例在手术后均经１年以上的追踪。根据声带长短及甲状软骨前角角度大小的差异，采用了不同类型的手术方法。其中，行一侧构状软骨摘除声带外展术（Ｗｏｏｄｍａｎ术式）者１５例，术后声门裂最大径≥４ｍｍ者有８例，拔除气管插管者有１１例。对声带长度短、甲状软骨前角角度较小的患者，经喉裂开行改良半喉切除声门扩大术者共９例，其中８例术后声门裂达到４ｍｍ，并拔除了气管插管，但术后声音嘶哑较明显。另３例行环构后肌神经肌蒂移植术，无一例声门裂较术前扩大。这虽是保存发音和改善呼吸的一种生理性手术，但临床疗效难肯定，尚需改进。

patients with bilateral vocal cord peralysis were treatedin the First Clinical MedicalCollege of Beijing Medical University. and all of them were followed up at least one year after treat-ment. According to the length of the vocal cord and the degree of the anterior angle of the thyroid carti-lage, one of the three different surgical procedures would be selected to alleviate the symptoms of bilater-al abductor paralysis. The width of glottic chink after treatment is the paramount index. The averageestimated size of the posterior glottic chink or point of maximum width of glottic chink should be equalto or bigger than 4mm after surgical treatment.The open approach to arytenoidectomy-Woodman'sTechnique was performed in 15 patients,and among them the tracheal cannulas were removed in 11 cas-es, and 8 cases had a glottic chink bigger than 4mm width.In 9 cases with short length vocal cord andnarrow anterior angle of the thyroid cartilage,a moodified hemilaryngectomy was used by thyrotomicalapproach, and a successful result was obtained with good to excellent exercise tolerance for social activi-ty. Unfortunately,in the remaining 3 patients,the nerve-muscle pedicle technique reinnervation ofbilateral vocal cord paralysis was applied,and no patient demonstrated visible inspiratory vocal cord ab-duction. Although this type of operation might totally reconstruct respiratory function without phona-tion impairment, the clinical result was not certain.