单侧杓状软骨切除术联合同侧声带外移治疗双侧声带麻痹的疗效观察

Unilateral arytenoid cartilage resection combined with homolateral cordopexy for the treatment of bilateral vocal cord paralysis

目的探讨单侧杓状软骨切除术联合同侧声带外移治疗双侧声带麻痹的临床疗效。方法回顾分析2007年1月至2011年4月5例双侧声带麻痹患者的临床资料,所有患者均在全麻下行颈外径路单侧杓状软骨切除术联合同侧声带外移,观察术后临床效果和术前、术后6月患者的声学参数(基频-F_0,基频微扰-jitter,振幅微扰-shimmer,标准化噪声能量-NNE和最长声时(MPT)。结果患者术后呼吸功能均显著改善,5例患者均成功1次拔管,平均拔管时间(18.67±4.83)d,发音质量无显著下降,术后随访6月无严重误吸、创面肉芽、再狭窄发生。术后6月患者的F_0、jitter、shimmer、NNE显著降低,而MPT显著延长,P<0.05。结论单侧杓状软骨切除术联合同侧声带外移治疗双侧声带麻痹临床效果好,无明显并发症,显著改善患者的声学参数和最大声时。

Objective To evaluate the efficacy of unilateral arytenoid cartilage resection combined with homolateral cordopexy for the treatment of bilateral vocal cord paralysis. Methods The clinical data of five cases with bilateral recurrent laryngeal nerve paralysis were retrospectively analyzed from January 2007 to April 2011. All patients were treated with unilateral carotid diameter path resection of arytenoid cartilage combined with relocation of the ipsilateral vocal cord undergoning total general anesthesia.The clinical results acoustic parameters （fundamental frequency, F0, fundamental frequency perturbation-jitter~ amplitude perturbation-shimmer, normalized noise energy, NNE, and maximal phonatory time, MPT） were observed before and 6 months after operation. Results Postoperative respiratory function were significantly improved, and all of the 5 patients were successfully extubated 18.67 ＋ 4.83 days after the operation. There were no significant decline in the quality of pronunciation and no serious follow-up aspiration. No complication such as granulation formation and restenosis was recorded. The mean values of F0, jitter, shimmer, NNE significantly were significantly decreased after operation in comparison with the preoperative data （P〈0.05）. MPT were significantly longer after operation than before the operation （P〈0.05）. Conclusion Unilateral arytenoid cartilage resection combined with homolateral cordopexy for the treatment of bilateral vocal cord paralysis were effective without significant complications. It also significantly improved the voice in acoustic parameters and MPT.