CO_2激光单侧杓状软骨次全切除术治疗双侧外展性声带麻痹

CO_2 laser endoscopic subtotal arytenoidectomy for bilateral median vocal cord paralysis

目的 探讨CO2 激光单侧杓状软骨次全切除术治疗双侧外展性声带麻痹手术的适应证及临床意义。方法 支撑喉镜下对 8例双侧外展性声带麻痹伴呼吸困难的患者实施了CO2 激光单侧杓状软骨次全切除术和手术创面黏膜吻合术。其中 ,继发于双侧甲状腺切除术 5例 ,外伤所致双侧外展性声带麻痹 2例 ,原因不明 1例。术前接受气管造口术 5例 ,气管切开术 1例。术后通过纤维喉镜检查患者新建声门裂的通气情况 ,发音质量主观评估由患者本人和医疗小组共同完成。结果8例患者术后均恢复了满意的呼吸功能 ,发音质量均无明显下降 ,平均气管套管拔除时间为 44 2d。术后随访 5～ 43个月 ,没有出现误吸和再狭窄等并发症。结论 支撑喉镜下CO2 激光单侧杓状软骨次全切除术和创面黏膜吻合术简单易行 ,创面小 ,术后愈合快 ,可避免肉芽组织增生和瘢痕形成所导致的声门区再狭窄 。

Objective To delineate the surgical procedures and correlated techniques for endoscopic subtotal arytenoidectomy, as well as to discuss their applications and clinical outcomes Methods CO 2 Laser endoscopic unilateral arytenoidectomy was performed in eight cases of bilateral median vocal cord paralysis combined with one stage of mucosal micro-anastomosis All patients suffered from dyspnea in some extent, of which 5 had the history of thyroidectomy and 2 had traumatic causes following esophagectomy and tracheal surgery respectively One of patient had unknown cause Six patients had undergone tracheotomy prior to operation or before their referral to our hospital The airway was evaluated vi a fibro-optic laryngoscopy, and the voice quality was assessed subjectively by the patients and the surgeon before and after surgery. Results Following 5-43 months after the surgery, in all cases the function of airway as well as the acceptable voice quality was successfully restored The tracheotomy done before operation in six patients was decannulated within the mean time of 44 2 days post-operation Conclusion The endoscopic approach for CO 2 laser unilateral arytenoidectomy may lead to better restoration of an adequate airway and satisfying phonation without postoperative aspiration Mucosal micro-anastomosis can prevent the formation of granulation or scar tissue thus promotes the healing processes This procedure is simpler than other ordinary surgical methods, and could be a satisfactory alternation of treatment for bilateral median vocal cord paralysis