单侧杓状软骨加声带后部低温等离子射频消融术治疗双侧声带麻痹疗效分析

发布时间：2018-02-05 05:27

本文关键词： 声带麻痹杓状软骨切除术低温等离子射频消融　出处：《听力学及言语疾病杂志》2014年02期 　论文类型：期刊论文

【摘要】：目的探讨视频支撑喉镜下单侧杓状软骨及声带后部低温等离子射频消融术治疗双侧声带麻痹的疗效。方法 2009~2012年解放军总医院耳鼻咽喉头颈外科对17例双侧声带麻痹患者(不全麻痹8例,完全麻痹9例)在视频支撑喉镜下行单侧杓状软骨及声带后部低温等离子射频消融术,手术前后行电子喉镜检查,评估声门裂大小和呼吸情况,并对患者进行嗓音听感知一致性评估(consensus auditory-perceptual evaluation of voice,CAPE-V)。结果术前喉镜检查8例不全麻痹者声带内收正常,外展受限,不超过旁正中位,9例完全麻痹者双侧声带固定,不能内收和外展,吸气时声门裂2~3mm,17例中3例已行气管切开。术后喉镜观察声门后部形成近三角形呼吸区,声门裂后端宽达到5~6mm,随访6~44个月,15例拔管(88.24%),其中1例因术后瘢痕挛缩,分别行声带后部和瘢痕切除术及对侧杓状软骨切除术,第3次术后2个月拔管。其余2例均已堵管未拔,其中1例为8岁的先心病患儿,1例为甲状腺癌手术加放疗后颈部瘢痕僵硬。术后仅2例患者声门后部手术区形成肉芽,未经处理自行消失。经CAPE-V评估嗓音质量提高2例,无变化10例,有所下降5例。结论单侧杓状软骨联合声带后部低温等离子射频消融术治疗双侧声带麻痹,疗效可靠,拔管率高,对发声功能影响小。
[Abstract]:Objective to investigate the therapeutic effect of hypothermic plasma radiofrequency ablation of unilateral arytenoid cartilage and vocal cord under video-supported laryngoscope for bilateral vocal cord paralysis. From 2009 to 2012, 17 patients with bilateral vocal cord paralysis were treated by otolaryngology, head and neck surgery, PLA General Hospital. There were 8 cases of incomplete paralysis. Nine patients with complete paralysis were treated with radiofrequency ablation of unilateral arytenoid cartilage and the posterior part of vocal cord under video-supported laryngoscope. The size and respiration of glottic fissure were evaluated by electronic laryngoscope before and after operation. The consensus auditory-perceptual evaluation of voice were evaluated. Results preoperative laryngoscope examination showed that 8 cases of incomplete paralysis had normal vocal cord adduction, limited abduction, bilateral vocal cord fixation and no adduction and abduction in 9 cases with complete paralysis. Tracheotomy was performed in 3 of 17 patients with glottic fissure at inspiratory time. After laryngoscope, the posterior glottis formed a nearly triangular breathing area, and the width of the posterior end of glottic fissure was up to 5mm. The follow-up was 6 ~ 44 months. 15 cases had extubation and 88.24 suture, of which 1 case underwent posterior vocal cord resection and cicatricectomy and contralateral arytenoid cartilage resection due to postoperative cicatricial contracture. 2 months after the third operation, the remaining 2 cases were not pulled out, one of them was a child with congenital heart disease aged 8 years. One case was neck scar stiffness after operation and radiotherapy for thyroid carcinoma. Only 2 cases developed granulation in the posterior glottic area after operation and disappeared without treatment. The quality of voice was improved by CAPE-V in 2 cases. Conclusion unilateral arytenoid cartilage combined with low temperature plasma radiofrequency ablation in the posterior part of vocal cord for bilateral vocal cord paralysis has reliable curative effect, high extubation rate and little influence on vocal function.
【作者单位】：解放军总医院耳鼻咽喉头颈外科;
【分类号】：R764
【正文快照】： 手术、外伤、细菌或病毒感染、肿瘤压迫或侵犯等原因可致喉返神经、喉上神经损伤,引起喉内肌失神经支配,造成声带麻痹。双侧声带不全麻痹者吸气时声带不能外展,可出现吸气性呼吸困难;双侧声带完全麻痹者声带固定,发声时声带不能内收导致气息音,声音嘶哑,音量小,在剧烈运动、上

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