支撑喉镜下CO_2激光杓状软骨部分切除术治疗双侧声带麻痹的疗效分析
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摘要
目的探讨支撑喉镜下CO_2激光杓状软骨部分切除治疗双侧声带麻痹的疗效。方法回顾分析2010年1月至2017年6月期间诊断为双侧声带麻痹,并在山东大学齐鲁医院耳鼻咽喉科接受支撑喉镜CO_2激光杓状软骨部分切除术患者26例,统计患者的拔管率、术后拔管时间、手术次数、住院时间、并发症发生率。评价支撑喉镜CO_2激光切除声带后部及部分杓状软骨切除术的疗效。结果所有患者均于术后5～10 d出院。吞咽功能恢复率100%,无喉部水肿窒息、严重误吸、严重出血并发症。拔管率88%,拔管时间为术后2～25个月;再手术率36%,9例中1例接受3次手术。主观嗓音较术前无实质性下降者为52%(13/25)。拔管患者中21例自觉日常生活及轻度运动无呼吸困难。结论支撑喉镜CO_2激光杓状软骨部分切除术具有创伤小、术后恢复快、并发症发生率低,兼顾呼吸改善和嗓音、吞咽功能保护的优点,疗效确切,是治疗双侧声带麻痹的可靠术式。提高术后拔管率的关键在于控制手术区肉芽组织及瘢痕的生长。
Objective To evaluate the effect of endoscopic carbon dioxide laser partial arytenoidectomy in the treatment of bilateral vocal cord paralysis. Methods Twenty-six patients diagnosed with bilateral vocal cord paralysis and hospitalized at the Qilu Hospital of Shandong University to undergo endoscopic carbon dioxide laser partial arytenoidectomy between January 2010 and June 2017 were included in this retrospective study. And evaluate the decannulation rate,hospitalization time,times of surgery, complication rate. Results All patients were discharged from the hospital within 7 to 10 days after surgery following satisfactory recovery of their swallowing function. No severe laryngeal edema,aspiration,apnea,and/or bleeding were observed in the postoperative period. The rate of decannulation was 88%,while the re-intervention rate was 36%. 52% of the patients did not perceive any considerable impairment in their voice quality compared to pre-operative voice quality. Conclusion Endoscopic carbon dioxide laser posterior cordectomy and partial arytenoidectomy is a reliable method for the treatment of bilateral vocal cord paralysis. The key factor for improving the rate of decannulation is regulating the formation of granulation tissue and scars.
Objective To evaluate the effect of endoscopic carbon dioxide laser partial arytenoidectomy in the treatment of bilateral vocal cord paralysis. Methods Twenty-six patients diagnosed with bilateral vocal cord paralysis and hospitalized at the Qilu Hospital of Shandong University to undergo endoscopic carbon dioxide laser partial arytenoidectomy between January 2010 and June 2017 were included in this retrospective study. And evaluate the decannulation rate,hospitalization time,times of surgery, complication rate. Results All patients were discharged from the hospital within 7 to 10 days after surgery following satisfactory recovery of their swallowing function. No severe laryngeal edema,aspiration,apnea,and/or bleeding were observed in the postoperative period. The rate of decannulation was 88%,while the re-intervention rate was 36%. 52% of the patients did not perceive any considerable impairment in their voice quality compared to pre-operative voice quality. Conclusion Endoscopic carbon dioxide laser posterior cordectomy and partial arytenoidectomy is a reliable method for the treatment of bilateral vocal cord paralysis. The key factor for improving the rate of decannulation is regulating the formation of granulation tissue and scars.
引文
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[3]Ozdemir S,TuncerU,TarkanO,et al. Carbon dioxide laser endoscopic posterior cordotomy technique for bilateral abductor vocal cord paralysis:a 15-year experience[J].JAM A Otolaryngol Head Neck Surg,2013,139(4):401-404.
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[8]Li Y,Garrett G,Zealear D. Current treatment options for bilateral vocal fold paralysis:a state of the art review[J].Clin Exp Otorhinolaryngol,2017,10(3):203-212.
[9]Dispenza F,Dispenza C,Marchese D. Treatment of bilateral vocal cord paralysis follow ing permanent recurrent laryngeal nerve injury[J]. Am J Otolaryngol,2012,33(3):285-288.
[10]Thornell WC. A new intralaryngeal approach for arytenoidectomy in the treatment of bilateral abductor vocal cord paralysis[J]. J Clin Endocrinol M etab,1950,10(9):1118-1125.
[11]Ossoff RH,Sisson GA,Duncavage JA,et al. Endoscopic laser arytenoidectomy for the treatment of bilateral vocal cord paralysis[J]. Laryngoscope,1984,94(10):1293-1297.
[12]Dennis DP,Kashima H. Carbon dioxide laser posterior cordectomy for treatment of bilateral vocal cord paralysis[J]. Ann Otol Rhinol Laryngol,1989,98(12 Pt 1):930-934.
[13] Crumley RL. Endoscopic laser medial arytenoidectomy for airw ay management in bilateral laryngeal paralysis[J]. Ann Otol Rhinol Laryngol,1993,102(2):81-84.
[14]Remacle M,Lawson G,Mayne A,et al. Subtotal carbon dioxide laser arytenoidectomy by endoscopic approach for treatment of bilateral cord immobility in adduction[J]. Ann Otol Rhinol Laryngol,1996,105(6):438-445.
[15]Misiolek M,Waler J,Namyslowski G,et al. Recurrent laryngeal nerve palsy after thyroid cancer surgery:a laryngological and surgical problem[J]. Eur Arch Otorhinolaryngol,2001,258(9):460-462.
[16] Asik MB,Karasimav O,Birkent H,et al. Impact of unilateral carbon dioxide laser posterior transverse cordotomy on vocal and aerodynamic parameters in bilateral vocal fold paralysis[J]. J Laryngol Otol,2016,130(4):373-379.
[17]Yilmaz T,Altuntas OM,Suslu N,et al. Total and partial laser arytenoidectomy for bilateral vocal fold paralysis[J]. Biomed Res Int,2016:3601612. DOI:10.1155/2016/3601612.
[18]Yilmaz T,SüslüN,Atay G,et al. Comparison of voice and sw allow ing parameters after endoscopic total and partial arytenoidectomy for bilateral abductor vocal fold paralysis:a randomized trial[J]. JAM A Otolaryngol Head Neck Surg,2013,139(7):712-718.
[2]Chen X,Wan P,Yu Y,et al. Types and timing of therapy for vocal fold paresis/paralysis after thyroidectomy:a systematic review and meta-analysis[J]. J Voice,2014,28(6):799-808.
[3]Ozdemir S,TuncerU,TarkanO,et al. Carbon dioxide laser endoscopic posterior cordotomy technique for bilateral abductor vocal cord paralysis:a 15-year experience[J].JAM A Otolaryngol Head Neck Surg,2013,139(4):401-404.
[4]Mueller AH. Laryngeal pacing for bilateral vocal fold immobility[J]. Curr Opin Otolaryngol Head Neck Surg,2011,19(6):439-443.
[5]Hillel AD,Benninger M,Blitzer A,et al. Evaluation and management of bilateral vocal cord immobility[J]. Otolaryngol Head Neck Surg,1999,121(6):760-765.
[6]Benninger MS,Gillen JB,Altman JS. Changing etiology of vocal fold immobility[J]. Laryngoscope,1998,108(9):1346-1350.
[7]Eckel HE,Sittel C. Bilateral recurrent laryngeal nerve paralysis[J]. HNO,2001,49(3):166-179.
[8]Li Y,Garrett G,Zealear D. Current treatment options for bilateral vocal fold paralysis:a state of the art review[J].Clin Exp Otorhinolaryngol,2017,10(3):203-212.
[9]Dispenza F,Dispenza C,Marchese D. Treatment of bilateral vocal cord paralysis follow ing permanent recurrent laryngeal nerve injury[J]. Am J Otolaryngol,2012,33(3):285-288.
[10]Thornell WC. A new intralaryngeal approach for arytenoidectomy in the treatment of bilateral abductor vocal cord paralysis[J]. J Clin Endocrinol M etab,1950,10(9):1118-1125.
[11]Ossoff RH,Sisson GA,Duncavage JA,et al. Endoscopic laser arytenoidectomy for the treatment of bilateral vocal cord paralysis[J]. Laryngoscope,1984,94(10):1293-1297.
[12]Dennis DP,Kashima H. Carbon dioxide laser posterior cordectomy for treatment of bilateral vocal cord paralysis[J]. Ann Otol Rhinol Laryngol,1989,98(12 Pt 1):930-934.
[13] Crumley RL. Endoscopic laser medial arytenoidectomy for airw ay management in bilateral laryngeal paralysis[J]. Ann Otol Rhinol Laryngol,1993,102(2):81-84.
[14]Remacle M,Lawson G,Mayne A,et al. Subtotal carbon dioxide laser arytenoidectomy by endoscopic approach for treatment of bilateral cord immobility in adduction[J]. Ann Otol Rhinol Laryngol,1996,105(6):438-445.
[15]Misiolek M,Waler J,Namyslowski G,et al. Recurrent laryngeal nerve palsy after thyroid cancer surgery:a laryngological and surgical problem[J]. Eur Arch Otorhinolaryngol,2001,258(9):460-462.
[16] Asik MB,Karasimav O,Birkent H,et al. Impact of unilateral carbon dioxide laser posterior transverse cordotomy on vocal and aerodynamic parameters in bilateral vocal fold paralysis[J]. J Laryngol Otol,2016,130(4):373-379.
[17]Yilmaz T,Altuntas OM,Suslu N,et al. Total and partial laser arytenoidectomy for bilateral vocal fold paralysis[J]. Biomed Res Int,2016:3601612. DOI:10.1155/2016/3601612.
[18]Yilmaz T,SüslüN,Atay G,et al. Comparison of voice and sw allow ing parameters after endoscopic total and partial arytenoidectomy for bilateral abductor vocal fold paralysis:a randomized trial[J]. JAM A Otolaryngol Head Neck Surg,2013,139(7):712-718.