支撑喉镜下CO_2激光单侧杓状软骨切除术治疗双侧声带麻痹

陈召灵;吕秋萍;孙敬武;万光伦;汪银凤;

1:安徽医科大学附属安徽省立医院耳鼻咽喉头颈外科

摘要

目的探讨支撑喉镜下CO2激光单侧杓状软骨切除术治疗双侧声带麻痹的疗效。方法对6例双侧声带外展麻痹(均有不同程度呼吸困难)和3例双侧声带完全麻痹(有不同程度声嘶及呼吸不畅)患者实施了支撑喉镜下CO2激光单侧杓状软骨切除术,其中,8例进行了手术创面黏膜吻合术。所有患者手术前后均行频闪喉镜检查观察声门裂大小及通气情况,并由患者本人和医疗小组共同完成发声质量评估。结果术前行频闪喉镜检查示:6例声带不完全麻痹者声带内收正常,外展受限,仅达旁正中位,其中3例已行气管切开者吸气时声门裂后端宽约1～2mm,3例双声带完全麻痹者发声时声门不能闭合,吸气时声门裂后端宽约3～3.5mm。术后随访11～34个月,7例无呼吸困难,均能保持术前的嗓音质量,1例术后1个月局部肉芽增生,另1例术后6个月后瘢痕挛缩,不能堵管,该2例均再次手术后呼吸平稳,未再次出现呼吸困难,但1例发声质量较前次手术后差。术后频闪喉镜检查,所有患者喉内手术创面黏膜愈合良好,声门裂后1/3形成近三角形裂隙,声门裂后端深吸气时宽度均大于4mm。结论 CO2激光单侧杓状软骨切除术可有效改善双侧声带麻痹导致的呼吸困难,发声功能较满意。

关键词

声带麻痹;激光手术;杓状软骨

基金项目(Foundation):

作者

陈召灵;吕秋萍;孙敬武;万光伦;汪银凤;

参考文献

1姜泗长,顾瑞,何凌汉,等.手术学全集耳鼻喉科卷[M].北京:人民卫生出版社,1996.528～533.

2 Misiolek M,Ziora D,Namyslowski G,et al.Long term results in patients after combined laser total aryte-niodectomy with posterior cordectomy for bilateral vocal cord paralysis[J].Eur Arch Otorhinolaryngol,2007,264:895.

3 Ossoff RH,Karlan MS,Sisson GA.Endoscopic laser aryt-enoidectomy[J].Lasers Surg Med,1983,2:293.

4 Ossoff RH,Sisson GA,DuncavageJA.et al.Endoscopic laser arytenoidectomy for the treatment 0fbilat-eral vocal cord pa-ralysis[J].Laryngoscope,1984,94:1 293.

5 Sato K,Umeno H,Nakashima T,et al.Laser arytenoidectomy for bilateral median vocal fold fixation[J].Laryngoscope,2001,111:168.

6秦永,肖水芳,王尽桂,等.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[J].中华耳鼻咽喉科杂志,2003,38:292.

7 Wani MK,Yarber R,Hengersteg A.et al.Endoscopic laser me-dial arytenoidectomy versus total arytenoidectomy in the man-agement of bilateral vocal fold paralysis[J].Ann Otol Rhinol Laryngol,1996,105:857.

8 Sato K,Yoshida T,Umeno H,et al.Iaser Arytenoidectomy for bilateral vocal fold paralysis[J].Nihon Jibiinkoka Gakkai Kaiho,2000,103:147

9 Danino J,Gouldenberg D,Jochims HZ.et al.Submucosal ary-tenoidectomy:new surgical technique and review of the litera-ture[J].Otolaryngol,2000,29:13.

10王军,马丽晶,叶京英,等.显微缝合技术在喉显微外科手术中的应用[J].临床耳鼻咽喉头颈外科杂志,2008,22:965.

11 Ossoff RH,Duncavage JA,Shapshay SM,et al.Endoscopic laser arytenoidectomy revisited[J].Ann Otol Rhinol Laryn-gol,1990,99:764.

12柳端今,徐文.支撑喉镜下CO2激光杓状软骨切除术治疗双声带外展麻痹[J].中华耳鼻咽喉科杂志,1999,34:365.

13黄益灯,周水淼,郑宏良,等.成人杓状软骨切除术前后声门测量及嗓音分析[J].中华耳鼻咽喉科杂志,2004,39:554.

14 Bigenzahn W,Hoefler H.Minimally invasive laser surgery for the treatment of bilateral vocal cord paralysis[J].Laryn-goscope,1996,106:791.

15 Manolopoulos L,Stavroulaki P,Yiotakis J,et al.CO2 and KTP-532laser cordectomy for bilateral vocal paralysis[J].Laryngol Otol,1999,113:637.

16 Danino J,Goldenberg D,Joachims HZ.Submucosal aryteno-idectomy:new surgical technique and review of the litera-ture[J].Otolaryngol,2000,29:13.

17 Havas TE,Priestley KJ.Laser tenotomy and vocal process re-section for bilateral midline vocal fold fixation[J].ANZ J Surg,2003,73:326

本文信息

PDF(150K)

本文关键词相关文章

声带麻痹激光手术杓状软骨

本文作者相关文章

陈召灵吕秋萍孙敬武万光伦汪银凤