内镜辅助半导体激光切除一侧杓状软骨治疗双侧声带外展麻痹

A Preliminary Study of Endoscope-Assisted Arytenoidectomy with Semiconductor Diode Laser Under Self-Retaining Laryngoscope for Treating the Bilateral Vocal Cord Paralysis

目的探讨内镜辅助支撑喉镜下半导体激光切除一侧杓状软骨治疗双侧声带外展麻痹致呼吸困难的疗效。方法 35例双侧声带外展麻痹伴呼吸困难的患者在全麻内镜辅助支撑喉镜下应用半导体激光切除一侧杓状软骨,使声门裂后份宽4～5mm,术后随访3～36个月,观察治疗效果。结果 35例中,术后33例(94.29%,33/35)患者呼吸困难明显缓解,顺利拔除气管套管,平均拔管时间35d,并保留了较好的发声功能,其中30例(85.71%,30/35)发声效果较满意。2例外伤患者需长期带管。所有患者术后吞咽功能均恢复正常。结论内镜辅助支撑喉镜下半导体激光切除一侧杓状软骨治疗双侧声带外展麻痹伴呼吸困难患者手术创伤轻,可有效解除呼吸困难,术后拔管率高,并发症少,并可保留较好的发声功能。

Objective To investigate the clinical effect of endoscope-assisted arytenoidectomy with semiconductor diode laser（SCDL）under self-retaining laryngoscope for treating the bilateral vocal cord paralysis.Methods Endoscope-assisted one side arytenoidectomy with semiconductor diode laser（SCDL）under self-retaining laryngoscope was performed in anaesthetic 35patients with bilateral vocal cord paralysis.The posterior glottic fissure was enlarged to about 4～5mm to relieve dyspnea.Results The symptom of dyspnea of 33patients among 35cases with bilateral vocal cord paralysis obviously alleviate after operation,except 2trauma cases who need tracheal tube for a long time.There was a satisfactory vocal effect among all 30cases after operation and the effective rate was 85.7%.The swallowing function of all postoperative patients became normal without complications such as aspiration and glottis restenosis.All trachea cannula cases extracted successfully,and the average extubation time was 35d.Conclusion Endoscope-assisted arytenoidectomy with semiconductor diode laser under self-retaining laryngoscope is worthy of clinical application.Due to less trauma,high rate of postoperative extubation,presewation of pronunciation function and less complications.