双侧声带麻痹内镜激光与喉外径路杓状软骨切除手术量化分析

The comparison of arytenoid resection surgical effect between endoscopic laser approach and external cervical approach for bilateral vocal cord fold paralysis

目的:比较内镜CO2激光与喉外径路杓状软骨切除术治疗双侧声带麻痹的疗效及并发症。方法:将78例双侧声带麻痹的患者分为激光组(30例)和喉外组(48例),分别采用内镜CO2激光杓状软骨切除术和喉外径路杓状软骨切除术。所有患者手术前后接受动态喉镜、嗓音听感知评估(RBH)、最长发声时间(MPT)检查及拔管率分析评估临床疗效。结果:两组术后术侧声带位置较术前均有显著性外移(P<0.05);两组发声时声门闭合较术前均有不同程度的增大,但激光组的增大差异无统计学意义,而喉外组有统计学意义(P<0.05);声带位置及声门闭合程度两组间比较差异无统计学意义(P>0.05)。术后两组听感知评估3个参数R、B、H较术前有明显加重(均P<0.05),两组MPT较术前均有缩短(P<0.05);但两组间差异无统计学意义(P>0.05)。两组总拔管率分别为90.0%(27/30)和95.8%(46/48),差异无统计学意义。术后两组均表现出不同程度的误吸,除喉外组1例患者反复误吸引起肺炎外,其他患者均自行缓解。结论:内镜激光和喉外径路杓状软骨切除术后患者嗓音均有明显损害,但能建立足够气道,缓解呼吸困难。

Objective：To investigate the surgical effect and complications of arytenoid resection in bilateral vocal cord fold paralysis（BVFP）patients via endoscopic laser approach and external cervical approach.Method：A total seventy-eight BVFP patients who underwent arytenoid resection surgery via endoscopic laser approach（laser group,n=30）or external cervical approach（external cervical group,n=48）were enrolled in this study.Videostroboscopy,vocal perception evaluation,maximum phonation time（MPT）text were preformed in all patients both preoperatively and postoperatively.The decannulation rate was also calculated.Result：Videostroboscopy showed that vocal fold on the operated side in both groups could abduct to various extent postoperatively,which showed significant difference when compared with preoperative abductive movements（P〈0.05）.Postoperative glottal closure showed various increment in both groups.However,when with preoperative glottal closure,external cervical group showed significant difference（P〈0.05）,while laser group showed no significant difference（P〉0.05）.Postoperative videostroboscopy showed no significant difference in vocal fold position and glottal closure between these two groups（P〉0.05）.Vocal perceptual evaluation（RBH score）showed a significant deterioration in voice quality postoperatively in both groups respectively（P〈0.05）.Postoperative MPT values showed no significant difference between the two groups（P〉0.05）.However,they were significantly shorten/shorter than preoperative ones in these two groups respectively（P〈0.05）.The overall decannulation rate were 90.0% and 95.8%for laser group and external cervical group respectively.In Both groups,patients presented aspiration symptoms postoperatively,except one patient of external cervical group who developed pneumonia due to recurrent aspiration.Conclusion：Arytenoid resection surgery via both endoscopic laser approach and external cervical approach can both enlarge glottic area so as to solve respiration problems in BVFP patients.Two kinds of surgery have obvious voice damage.