声带麻痹病因分析和治疗方法的探讨

目的：寻找声带麻痹的病因和有效的治疗方法。方法：分析65例声带麻痹患者的临床资料，65例患者均经间接喉镜、动态喉镜或电子喉镜检查；其中31例行杓状软骨拨动术治疗。结果：由颈、胸部肿瘤引起声带麻痹14例；感染引起9例；颈、胸、腹部手术引起16例；气管插管引起12例；胃管插管引起3例；不明原因11例。治疗后声带麻痹消失37例，好转1例，有效率为58．46％；无效27例。结论：临床上对声音嘶哑的患者，应进行常规的间接喉镜、动态喉镜或电子喉镜检查。对有声带麻痹的患者应尽早在间接喉镜、直接喉镜或支撑喉镜下行杓状软骨拨动术。     

368例声带麻痹病因分析

目的分析、了解声带麻痹病因的分布情况，为诊治提供参考依据。方法对1993～2003年在我科内窥镜室经硬管喉镜和纤维喉镜检查确诊的368名声带麻痹患者的临床资料进行回顾性分析。结果其病因可分为7大类。在这7类病因中，由肿瘤及占位病变引起的居首位，共有133例，占36．1％，左右两侧无显著性差异；手术损伤居第2位，共99例，占26．9％；其它类声带麻痹位于第3位，共88例，占23．9％；“感冒”发烧后引起者居第4位，有33例，占9％；创伤居第5位，有7例，占1．9％；脑血管意外引起声带麻痹5例，占1．4％；排在最后位的是结核引起的声带麻痹，共3例，占0．8％。结论头颈部肿瘤引起的声带麻痹最多见，胸部病变及胸部手术引起的也较多，在诊断和治疗上须引起注意。病毒感染也是引起声带麻痹的原因之一。     

236例声带麻痹病因分析

声带麻痹在耳鼻咽喉科较为常见，多为喉的神经、肌肉、环杓关节受到肿瘤的压迫、炎症的侵袭及外伤等原因引起，表现为环杓关节活动受限或固定，造成声带完全或不完全麻痹。为了进一步了解声带麻痹的原因，以便作出较为正确的临床诊断及治疗，本文收集了我科1994～2004年236例经间接喉镜、光导纤维喉镜检查确诊为声带麻痹患者的临床资料，对其病因进行回顾性分析，现报告如下。     

成人单侧声带麻痹病因及治疗现状分析

目的探讨成人单侧声带麻痹的病因及治疗现状。方法回顾性分析55例成人单侧声带麻痹患者的临床资料,比较不同侧别、不同性别声带麻痹的病因有无差异,并电话回访了解患者的治疗现状。结果成人单侧声带麻痹男性多见(37/55,67.27%),左侧为主(43/55,78.18%),病因以颈、胸部肿瘤为首(27/55,49.09%),其次为特发性声带麻痹(22/55,40%)。不同侧别声带麻痹的病因差异无统计学意义(χ^2=0.610,P=0.731),不同性别患者声带麻痹的病因差异有统计学意义(χ^2=8.939,P=0.011)。颈、胸部肿瘤患者中放弃治疗者居多(20/27,74.07%),特发性声带麻痹中部分患者可自愈(6/22,27.27%)。结论成人单侧声带麻痹男性多于女性,左侧多于右侧。成年人单侧声带麻痹的病因以颈、胸部肿瘤为主,多为恶性,且肿瘤分期晚,大部分患者放弃了后续治疗。不同侧别的患者病因在临床上无差异。不同性别患者的病因在临床上存在差异,男性单侧声带麻痹的首位病因为颈、胸部肿瘤,而女性则多为特发性声带麻痹。部分特发性单侧声带麻痹患者有自愈倾向。     

老年单侧声带麻痹病因分析(附51例报告)

目的：探讨老年人单侧声带麻痹的病因。方法：回顾性分析51例老年单侧声带麻痹患者的临床资料。结果：老年单侧声带麻痹病因中，恶性肿瘤占首位，为52．9％。结论：老年单侧声带麻痹者要警惕恶性肿瘤的可能，积极明确病因。对病因不明者，应定期复查。     

2580例声嘶患者临床分析和诊断

目的：对不同年龄声嘶患者的发病原因及临床特点进行分析总结。方法对2580例声嘶患者进行电子喉镜检查,并对检查结果及声嘶病因进行分析。结果2580例声嘶患者的主要病因及其例数分别为：声带小结906例、声带息肉659例、急慢性喉炎519例、声带麻痹151例,喉癌121例、喉乳头状瘤89例、声带囊肿71例、其他64例,它们在各个年龄组的分布不尽相同（P〈0.01）。结论不同年龄组引起声嘶的原因各不相同：小儿以声带小结、急慢性喉炎和喉乳头状瘤多见;中青年以声带息肉、小结、急慢性喉炎为主;老年人以喉癌、声带麻痹为主;值得注意,声音嘶哑可涉及临床多个科室,需多方面检查,认真鉴别,这有助于我们在临床工作中更准确的诊治疾病。     

甲状腺手术前后声带检查的临床意义

目的探讨甲状腺手术前后声带普查的必要性及临床应用价值。方法对2000年11月至2003年11月我科所有甲状腺手术患者手术前后进行间接喉镜或电子喉镜检查声带。结果术前检查有2例声带麻痹，其中1例无声嘶，2例均为甲状腺恶性肿瘤患者。术后声嘶7例，其中4例声带麻痹。术后声带普查有8例声带麻痹，其中4例无声嘶症状。结论甲状腺手术前后普查声带能为术后声嘶的诊断提供依据。     

双声带楔形切除术治疗双侧声带外展麻痹

目的：探讨治疗双侧声带外展麻痹的微创外科手术方式——显微支撑喉镜下CO2激光双声带楔形切除术的临床应用价值。方法：使用显微支撑喉镜激光手术系统,治疗4例双侧声带外展麻痹患者。结果：3例经过1次手术,1例经过2次手术,随访5-36个月,患者呼吸困难完全缓解,能耐受日常生活活动;4例均对自己的声音较为满意,能进行日常的生活交流。结论：显微支撑喉镜CO2激光双侧声带楔形切除术,不需气管切开,术后喉功能恢复快,并发症少。既能解决患者通气的要求,又能保证发声的质量,本方法治疗双侧声带外展麻痹有很好的临床推广使用价值。     

颈部异常患者的双进路法声带息肉摘除术

目的对明确有较大的声带息肉而伴有颈部异常（如体胖颈短、颈椎病）的患者，行纤维喉镜或直接喉镜手术困难，探索一种新的手术方式以及初步疗效分析。方法选择38例直径在3mm以上带蒂息肉和广基型息肉的患者，行双进路法声带息肉摘除术，即：纤维喉镜经鼻腔插入作为光导和手术观察窗，弯式声带息肉钳经口腔入喉摘除息肉，必要时用纤维喉镜活检钳修整残留息肉。结果手术均一次成功，术后随访6个月未见复发。结论该术式对有颈部异常患者的声带息肉有临床应用价值。     

声带血管扩张症21例临床分析

目的探讨声带血管扩张症的诊断和治疗。方法总结分析21例患者的临床资料。所有患者均有不同程度的声音嘶哑，其中女性15例，男性6例；年龄23～68岁，中位年龄44岁；血管扩张位于右侧声带12例，左侧声带9例。单纯声带血管扩张10例；声带血管扩张伴发声带息肉8例，伴发声带小结2例，伴发一侧声带麻痹1例。所有患者随访6个月以上。结果在电视喉镜下显示扩张的小血管从声带前端开始向后延伸至声带中部的6例，表现为扩张的血管在声带中部进一步扩张成类似小的血管瘤者3例，或表现点状、片状或短线状血管扩张12例。8例伴声带息肉的患者摘除声带息肉手术后复查见2例声带表面血管扩张消失，6例血管扩张无变化，声嘶明显改善；其余13例患者进行声带休息治疗，12例复查病变无变化，但声休后主观感觉声音嘶哑症状好转，1例患者未注意声带休息，3个月时因声音嘶哑加重，就诊发现对侧声带黏膜下出血，6个月复查时血管扩张未见变化，但对侧声带黏膜下出血吸收消失。结论声带血管扩张症好发于女性患者，做喉镜检查可明确诊断，治疗以声休为主，反复出血或持续声嘶者可考虑手术。     

Post-intubation vocal cord paralysis: the viral hypothesis. A case report

After digestive surgery, a 20-year-old man presented dysphonia and fever. Indirect laryngoscopy revealed a left vocal cord paralysis with no structural lesion. IgM and IgG were positive for cytomegalovirus and negative for human immunodeficiency virus, herpes simplex virus, varicella zoster virus and Epstein-Barr virus. The patient recovered spontaneously with a normal voice, and the mobility of vocal cord recovered within 3 months. The aetiology of post-intubation vocal cord paralysis (VCP) remains controversial. Vocal cord paralysis with cytomegalovirus has been reported in two cases associated with acquired immunodeficiency syndrome. Vocal cord paralysis secondary to viral disease has also been described in other circumstances. Received: 17 August 2000 / Accepted: 20 April 2001     

气管插管后声带运动障碍的原因及其相关因素

目的:分析气管插管全身麻醉术后声带运动障碍的原因及其相关因素。方法:通过电子喉镜、频闪喉镜检查、CT三维重建、杓状软骨拨动复位术治疗等判定135例全身麻醉术后声带运动障碍患者的原因。从患者插管条件与插管操作者技术水平、患者体态状况、年龄、带管时间、手术类别以及麻醉过程管理等方面分析声带运动障碍发生原因的相关因素。结果:135例患者中,128例(94.81%)声带运动障碍原因为杓状软骨脱位,7例(5.19%)为声带麻痹。声带运动障碍与插管困难有关者占76.30%;与麻醉过程起伏有关者达65.19%;在插管顺利的患者中,体态及颈部相对瘦长者占90.62%;不同年龄段所占比率差异无统计学意义;带管时间>12h的患者仅占全部声带运动障碍者的9.63%;心胸手术后出现声带运动障碍的发病率近0.50%,占全部声带运动障碍者的59.26%。结论:杓状软骨脱位及声带麻痹是全身麻醉术后声带运动障碍的主要原因;重视患者插管条件和麻醉过程管理,提高插管技术水平有可能降低声带运动障碍原因的发生。     

Sequelae of recurrent laryngeal nerve injury after patent ductus arteriosus ligation

OBJECTIVES: To prospectively study the clinical course of neonates with vocal cord paralysis (VCP) after patent ductus arteriosus (PDA) ligation. METHODS: A prospective cohort study of all premature infants undergoing PDA ligation from March 2001 to February 2004. Flexible laryngoscopy was performed after extubation to assess vocal cord function. Data regarding patient characteristics, operative findings, post-operative endoscopic findings, and the subsequent clinical course were collected. RESULTS: One hundred patients were enrolled. Flexible laryngoscopy was performed on 61 patients. Median birth weight was 740 g, gestational age 25 weeks, and age at operation 23 days. Flexible laryngoscopy was performed at an average of 8 days after extubation. Seven cases of vocal cord paralysis were identified. Two had stridor and feeding difficulty requiring nasogastric feeding. Five of the seven had an average follow-up of 9 months after surgery. At last follow-up, endoscopically satisfactory compensation by the normal vocal cord was observed in all five patients. No patient had feeding problems. CONCLUSIONS: The majority of infants who can be successfully extubated after PDA ligation tend to be asymptomatic despite vocal cord paralysis. Compensation appears to occur rapidly, and patients generally have no *long-term problems with the airway or feeding.     

A statistical study of clinical cases of malignant tumors first manifested by vocal cord paralysis

One of the most important problems in dealing with vocal cord paralysis is to clarify the cause of paralysis. In those case where the definite cause is unknown, it is possible that an occult type of malignant tumors exists along the course of the vagus or recurrent laryngeal nerves. For the past 16 years, 62 out of 560 cases with vocal cord paralysis were diagnosed to have malignant tumors first manifested by paralysis of vocal cord. They consisted of 25 cases of thyroid carcinoma, 18 lung carcinoma, 13 esophageal carcinoma, 3 mediastinal tumors and 3 tumors of miscellaneous origin. Among these, 36 were male and 26 were female and the mean age was 63 years old. In 40 cases, paralysis was found on the left side, in 18 on the right and bilaterally in the remaining 4. There was a marked sexual difference in the origin of malignant tumors, i.e. the incidence of lung carcinoma was higher in male with paralysis on the left side, while that of thyroid carcinoma was higher in female. In some cases with thyroid carcinoma, vocal cord paralysis was noted more than a year before the detection of the tumor. Ultrasonography of the neck, chest x-ray, CT scan of the chest, fluoroscopy of the pharyngo-esophagus should be performed for the detection of malignant tumors in cases with left vocal cord paralysis, while ultrasonography of the neck and chest x-ray should be sufficient in right paralysis, although additional fluoroscopy of the pharyngo-esophagus seemed preferable in male.     

高频超声与喉镜诊断声带麻痹的对照研究

目的探讨超声诊断声带麻痹的价值及局限性。方法分析33例声带麻痹的超声表现,并与喉镜对照。结果超声诊断为单侧和双侧声带麻痹者各为30和3例。单侧者声像图表现为单侧声带变形18例,运动和振动减弱或固定27例,声门裂扩大19例,杓状软骨运动减弱或固定30例,伴前移12例,梨状窝扩大25例,环杓后肌变薄、回声增强10例。双侧者声像图均表现为双声带变形、声门裂扩大、杓状软骨运动减弱。喉镜诊断单侧声带麻痹28例,双侧5例。超声诊断声带麻痹的符合率达93.9%。结论超声是诊断声带麻痹的一种无创、便捷、有效的方法,尤其可借助观察杓状软骨的运动来判断声带麻痹。     

173例声带麻痹患者的病因学特点

目的分析声带麻痹(VCP)患者的病因学特点。方法回顾性分析2016年9月—2019年9月于安徽医科大学附属省立医院耳鼻咽喉头颈外科就诊的173例确诊为VCP的患者,统计其临床特征并分析致病原因。结果173例VCP患者中,92例（53.2%）左侧VCP,36例（20.8%）右侧VCP,45例（26.0%）双侧VCP。医源性损伤包括：牵拉伤、热灼伤、离断伤等,损伤部位在左侧、右侧或双侧的不同解剖位置。医源性损伤105例（60.7%）居首位;其次是喉外肿瘤和占位性病变31例（17.9%）。结论单侧VCP较双侧VCP常见,左侧较右侧更为常见。不同病因所致VCP嗓音学特点各不相同,即使同一病因所致VCP,因损伤的程度、性质及解剖位置不同,嗓音学特征差异也较大,可比性较低。医源性损伤仍是导致VCP的首要原因,其次是喉外肿瘤和占位性病变。抗病毒药物、激素联合营养神经药物的保守治疗或可作为病毒感染或特发性病因的首选治疗,但对治疗效果不应抱有过高期待。     

Evaluation of recurrent nerve paralysis due to thoracic aortic aneurysm and aneurysm repair

OBJECTIVES: We sought to clarify the relationship between the outcome of recurrent laryngeal nerve paralysis with the characteristics of the thoracic aortic aneurysm and the surgical procedure used in each patient. METHODS: Nine patients who developed recurrent nerve paralysis (nonsurgical paralysis) due to a thoracic aortic aneurysm alone and 14 patients who underwent artificial vessel replacement for thoracic aortic aneurysm and developed recurrent nerve paralysis postoperatively (surgical paralysis) were evaluated. RESULTS: In the patients with nonsurgical paralysis, the aneurysms were similar in size to those of other patients who underwent surgery of the thoracic aorta and were invariably located near the aortic arch. Aneurysm shape was not associated with nerve paralysis. Surgical paralysis was alleviated in two patients. Surgical paralysis was observed in 9% of those who underwent surgery of the thoracic aorta. Vocal cord mobility recovered in 4 of the 11 patients with surgical paralysis who underwent follow-up. Symptoms were alleviated by rehabilitation in many patients who did not recover vocal cord mobility. The positions of the artificial vessel anastomoses are thought to be closely related to the outcome of paralysis. CONCLUSION: Recurrent nerve paralysis reduced not only the patient's quality of life but also survival by leading to disorders including aspiration pneumonia. Therefore, early rehabilitation should be performed, and surgical treatment should be considered, if necessary, for patients with recurrent nerve paralysis.     

两种手术方法治疗双侧声带神经麻痹

目的 通过观察经喉外进路及经支撑喉镜下行CO2激光手术切除杓状软骨治疗双侧声带神经麻痹的疗效,对比两种手术方法的优缺点,择优选取合适的术式。方法 对双侧喉返神经致喉狭窄的13例术后患者进行随访,其中7例行喉外进路杓状软骨切除术声带外展固定,6例行经支撑喉镜下行CO2激光手术切除杓状软骨,13例术前均已行气管切开,术后随访6个月至2年。结果 采用喉外进路杓状软骨切除术声带外展固定7例,术后1次拔管3例,2次拔管2例;采用经支撑喉镜下行CO2激光手术切除杓状软骨6例,术后1次拔管4例,2次拔管1例。结论 两种手术方法各有优缺点。     

Etiology of vocal cord paralysis

OBJECTIVE: Vocal cord paralysis (VCP) is a sign of a certain underlying disease, a diagnosis which can be attributed to various causes. This study intends to analyze the contemporary etiology of VCP in a tertiary medical center. MATERIALS AND METHODS: A retrospective review of medical records from June 2000 to December 2004 of hospitalized patients with VCP was done to determine the etiology. RESULTS: Two hundred and ninety-one patients with a determined etiology were identified, consisting of 176 males and 115 females. Unilateral VCP was present in 259 patients, while 32 presented with bilateral VCP. The causes were surgical in 40.2%, neoplastic in 29.9%, idiopathic in 10.7%, traumatic in 8%, central in 3.8%, radiation-induced in 3.4%, inflammatory in 2%, cardiovascular in 1.7% and other causes in 0.3% of the cases. Thyroidectomy represented the most common surgery for VCP and was the cause in 57 patients. Lung cancer was responsible for 34 cases and was the most common neoplastic etiology. In males, neoplasm was the most common cause occurring in 63 of 176 males, whereas surgery was most frequent in 59 of 115 females. CONCLUSION: Surgical trauma, mainly thyroidectomy, is the most common cause of VCP in hospitalized patients. The possibility of a neoplasm must be ruled out before VCP is labeled idiopathic. A benign thyroid tumor could also cause VCP. Besides, radiation-induced cranial nerve paralysis in head and neck cancer may play a significant role.