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

发布时间：2018-04-30 21:30

本文选题：声带麻痹 + CO激光　；参考：《临床耳鼻咽喉头颈外科杂志》2015年12期

【摘要】：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(P0.05);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(P0.05);声带位置及声门闭合程度两组间比较差异无统计学意义(P0.05)。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P0.05),两组MPT较术前均有缩短(P0.05);但两组间差异无统计学意义(P0.05)。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。
[Abstract]:Objective: to compare the efficacy and complications of endoscopic CO2 laser and external laryngeal approach arytenoid chondrotomy in the treatment of bilateral vocal cord paralysis. Methods: Seventy-eight patients with bilateral vocal cord paralysis were divided into laser group (n = 30) and extralaryngeal group (n = 48). The patients were treated with endoscopic CO2 laser arytenoid cartilage resection and external laryngeal diameter arytenoid chondrotomy respectively. All patients underwent dynamic laryngoscope, voice auditory perception assessment, MPT examination and extubation rate analysis before and after operation. Results: after operation, the position of vocal cord in the two groups was significantly different from that before operation (P 0.05), the glottic closure of the two groups was increased in different degree, but there was no significant difference between the laser group and the laser group. There was no significant difference in the position of vocal cord and the degree of glottic closure between the two groups. After operation, the three parameters of auditory perception assessment in the two groups were significantly worse than those before operation (P 0.05), and the MPT in both groups was shorter than that before operation (P 0.05), but there was no significant difference between the two groups (P 0.05). The total extubation rate of the two groups was 90.0% and 95.8%, respectively. There was no significant difference in the total extubation rate between the two groups. After operation, the two groups showed different degrees of aspiration, except for one patient in the larynx group who repeatedly attracted pneumonia by mistake, all the other patients were relieved by themselves. Conclusion: after endoscopic laser and external laryngeal approach arytenoid chondrotomy, the voice of the patients is obviously damaged, but it can establish enough airway to relieve dyspnea.
【作者单位】：第二军医大学附属长海医院耳鼻咽喉头颈外科;
【分类号】：R767.91

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