支撑喉镜下CO_2激光杓状软骨切除术治疗双声带外展麻痹

Endoscopic CO_2 laser arytenoidectomy in the treatment of bilateral vocal cord paralysis

目的 探讨支撑喉镜下CO2 激光显微杓状软骨切除术治疗双声带外展麻痹的手术方法、疗效和适应证。方法 1994～ 1998年收治双声带外展麻痹患者 8例 ,其中 3例曾在外院经颈外进路手术失败 ,全部术前行气管切开术。参照并改良Ossoff窥镜下杓状软骨切除术 ,汽化杓状软骨前部 ,包括声带突和部分肌突 ,一小部分室带及声带后端 ,保留粘软骨膜并缝合切口 ,以消灭创面 ,双侧分次手术。结果 术后无肉芽滋生 ,无误吸 ,保留发音功能。 5例拔管 ,2例日间堵管、因睡眠时喉鸣未予拔管 ,1例等待对侧手术。随诊 6个月～ 3 5年。结论 本方式弥补了单纯窥镜及外科手术不足 ,如粘膜出血、水肿、操作困难等 ,而具备显微外科精细、准确的特点。术后反应轻微 ,保留发音功能。

Objective To evaluate endoscopic CO 2 laser arytenoidectomy(ECO 2LA) for the treatment of bilateral vocal cord paralysis (BVCP) Methods Eight cases have been operated upon and observed for 6 to 40 months Three of them were extralaryngeal approach arytenoidectomy failures All of them had tracheostomy before The technique was to modification of Ossoff ECO 2LA model A small part of ventricular fold and posterior part of vocal cord was vaporized by laser The mucoperichondrium overlying the arytenoid was reserved and sutured After 3 months the opposite arytenoid was treated similarly Results There were no aspiration and no granulation at the surgical site postoperatively All cases kept satisfactory voice Five of 8 patients were decannulated Two patients still had laryngeal stridor during sleep and they had to plug the tracheotomy tube only on daytime One patient had cannula retained for waiting operation on the opposite side Conclusion ECO 2LA is currently a most reliable and efficient technique for treatment of patients with BVCP