单侧杓状软骨黏膜下次全切除并同侧声带外移治疗双侧声带外展麻痹

Unilateral Submucosal Arytenoidectomy and Lateral Cordopexy under Self-Retaining Laryngoscope for the Treatment of Bilateral Vocal Cord Paralysis

目的探讨支撑喉镜下单侧杓状软骨黏膜下次全切除并同侧声带外移治疗双侧声带外展麻痹的适应证及临床意义。方法支撑喉镜下对9例双侧声带外展麻痹伴呼吸困难的患者实施半导体激光(6例)或自制长针状单极电刀(3例)单侧杓状软骨次全切除术,然后利用穿刺针导入缝线于声带突后缘将声带拉向外侧,固定于甲状软骨上,其中8例为初次手术,1例为单侧杓状软骨激光部分切除术后失败病例。术后通过纤维喉镜检查患者声门的情况,并行发声质量主观评估。结果9例患者中8例术后恢复了满意的呼吸功能,其中3例发声质量无明显下降,5例声音质量较术前轻微下降,但不影响日常交流。术后7～14天8例即能全封管,观察至1～3个月拔管,平均拔管时间为45天。术后随访6～25个月,没有出现创面肉芽和再狭窄等并发症。1例(曾手术失败的病例)术后堵管失败,未能拔管,喉镜下见声门裂后端宽约2mm。结论支撑喉镜下单侧杓状软骨黏膜下次全切除并同侧声带外移可有效治疗双侧声带外展麻痹,方法简单易行,创伤小,拔管率高,患者的发声功能亦得到了满意的恢复和保留。

Objective To evaluate the application and clinical significance of unilateral submucosal arytenoid-ectomy and lateral cordopexy under self-retaining laryngoscope for the treatment of bilateral vocal cord paralysis. Methods Among 9 patients with bilateral vocal cord abductor paralysis with dyspnea, 8 were first treated and the remaining one was relapsed after unilateral submucosal arytenoidectomy. They were all treated with unilateral submucosal arytenordectomy under self- retaining laryngoscope with semiconductor laser or long- handle electric knife designed by ourselves, then the incision of aryepiglottic fold was sutured and the same vocal cord was abducted by fixing to the thyroid cartilage with suture. The glottis was examined with fibrolaryngoscope after operation and the voice quality was monitored by the doctor and patient together. Results Among the 9 patients, 8 cases had no longer dyspnea after operation, 3 of them had no decrease in voice quality while 5 ease had a mild reduction without af- fecting communication. All of them were obstructed with the traeheostomy tube in 7～14 days after operation, decannulated within 1 month to 3 months, and the average decannulated time was 45 days. During the follow-up of 6 to 25 months, no complication was noted, such as granulation formation and restenosis. Conclusion Unilateral sub- mucosal arytenoidectomy and lateral cordopexy under self-retaining laryngoscope is an effective treatment for bilateral abductor paralysis. It is easy to operate and has little invasive and a high deeannulated rate while the voice quality remains satisfying,