内镜支撑喉镜下低温等离子杓状软骨切除术治疗双侧声带外展麻痹

Endoscopic coblation assisted arytenoidectomy in the treatment of bilateral vocal cord paralysis

目的 探讨内镜支撑喉镜下低温等离子杓状软骨切除术治疗双侧声带外展麻痹的可行性及效果.方法 回顾分析大连市中心医院耳鼻咽喉头颈外科2008年至2012年收治的29例双侧声带外展麻痹患者,均行内镜支撑喉镜下低温等离子单侧杓状软骨切除术.手术前后行声门测量及嗓音分析.结果 29例患者术后1周内均成功拔管.术前及术后3个月患者平均（（x）±s,下同）声门面积为（21.9±4.7）mm2和（40.3±5.2）mm2,声门后部最大横径为（1.47 ±0.37） mm和（4.82±0.54）mm,差异均有统计学意义（t值分别为5.74和6.24,P值均＜0.05）.术后3个月26例（89.7％）患者对嗓音质量表示满意.手术前后嗓音声学参数中基频、基频微扰、振幅微扰的差异均无统计学意义（P值均＞0.05）；而最长发音时间差异有统计学意义（P＜0.05）.随访3个月至3.5年,中位数2年,患者均无呼吸困难,可从事轻体力劳动.结论 内镜支撑喉镜下低温等离子杓状软骨切除术治疗双侧声带外展麻痹是一种安全、微创、有效的手术方式.

Objective To introduce a new surgical technique for the treatment of bilateral vocal cord paralysis.Methods Twenty-nine patients with bilateral vocal cord paralysis treated in Dalian Municipal Central Hospital between 2008 and 2012 were retrospectively studied.Coblation assisted arytenoidectomy was performed in all cases.The pre and postoperative glottic measurement and vocal acoustic parameters were analyzed.Results All patients were decanulated 1 week after operation.Three months later,the mean glottic area increased from （21.9 ± 4.7） to （40.3 ± 5.2） mm2 （t =5.74.P 〈 0.05） ; the width of maximal glottic chink increased from （1.47 ±0.37） to （4.82 ±0.54） mm （t =6.24,P 〈 0.05）.Twenty-six patients （89.7%） satisfied with the voice quality.Acoustic parameters （F0,jitter,shimmer） were no significant difference （P 〉 0.05）,but there was a significant difference in maximum phonation time （P 〈 0.05）.During three months to 3.5 years follow-up,the patients had a stable airway and effective phonation.Conclusions Endoscopic coblation assisted arytenoidectomy is a new surgical method for the treatment of patients with bilateral vocal cord paralysis,which is efficient,minimally invasive and safe.