单侧杓状软骨切除微创黏膜瓣成形术治疗双侧声带麻痹66例的临床分析

Unilateral arytenoid chondroplasty combined with minimally invasive mucosal flap plasty for bilateral vocal cord paralysis--clinical analysis of 66 cases

目的分析单侧杓状软骨切除微创黏膜瓣成形术对于双侧声带麻痹患者的治疗效果。方法回顾性分析2018年1月至2023年12月中山大学附属第一医院住院治疗的66例双侧声带麻痹患者资料,其中男性8例,女性58例,年龄35~86(57.8±11.6)岁。所有患者在全身麻醉下行支撑喉镜CO_(2)激光单侧杓状软骨切除及黏膜瓣成形术。术后随访6个月~6年,中位随访时间28个月。对比患者手术前后的呼吸困难程度、声音质量(主客观评价),并对比分析术前/术中行气管切开与未行气管切开患者的临床差异,气管切开患者拔管率,复发率及并发症发生率。符合正态分布的连续性变量采用t检验,分类变量采用χ²检验,采用秩和检验分析手术前后呼吸困难改善程度。结果与术前相比,59例患者术后呼吸困难有改善(U=161.5,P<0.01);嗓音障碍指数10、主观听感知评估以及最大发声时间无明显差异(P值均>0.05),均在相对正常范围内。66例患者中32例行气管切开,以Ⅲ度呼吸困难为主(46.9%,15/32),其中术前已行气管切开患者26例,术中行气管切开患者6例;34例患者未行气管切开,以Ⅱ度呼吸困难为主(82.4%,28/34)。术后患者均顺利拔管,拔管平均中位时间1个月。结论单侧杓状软骨切除微创黏膜瓣成形术在治疗双侧声带麻痹方面,通过微创技术和黏膜瓣成形的应用,提供了一种更为精准和有效的治疗方案,或可有效减少气管切开的比例。

ObjectiveTo analyze the efficacy of unilateral arytenoid chondroplasty combined with minimally invasive mucosal flap plasty in the management bilateral vocal cord paralysis.MethodsA total of 66 patients with bilateral vocal cord paralysis hospitalized in the First Hospital of Sun Yat-sen University from January 2018 to December 2023 were retrospectively analyzed,among whom there were 8 males and 58 females,with ages ranging from 35 to 86 years old(mean age(57.8±11.6)years).All patients underwent suspension laryngoscopic CO_(2) laser unilateral arytenoid chondroplasty and mucosal flap under general anesthesia.Postoperative follow-up period extended from 6 months to 6 years,with a median duration of 28 months.The study compared the degree of dyspnea and voice quality(subjective and objective evaluation)of the patients pre-and post-operatively,and analyzed the clinical differences between patients with and without preoperative or intraoperative tracheotomy,the extubation rate of tracheotomized patients,the recurrence rate,and the complication rate.Continuous variables conforming to normal distribution were tested by t-test and categorical variables byχ²test,the Wilcoxon rank-sum test was used to analyze the improvement in dyspnea before and after surgery.ResultsCompared with the preoperative period,59 patients showed improvement in postoperative dyspnea(U=161.5,P<0.01);there was no significant difference in voice disorder index 10,subjective auditory-perceptual assessment,and maximal vocalization time(P>0.05),all of which remained within the relative normal range.Tracheotomy was performed in 32 out of 66 patients,with predominantly degreeⅢ-dyspnea(46.9%,15/32),including 26 patients with preoperative tracheotomy and 6 patients with intraoperative tracheotomy.Among the 34 patients who did not undergo tracheotomy,the majority presented with degreeⅡ-dyspnea(82.4%,28/34).All patients achieved successful extubation following surgery,with a mean median time to extubation of 1 month.ConclusionsThe combination of unilateral arytenoid chondroplasty and minimally invasive mucosal flap plasty represents a refined and effective therapeutic approach for bilateral vocal cord paralysis.This minimally invasive technique has the potential to reduce the rate of tracheotomy.