单侧声带粘膜下部分切除治疗双侧声带麻痹

双侧声带麻痹治疗较困难，我们采用粘膜下切除部分单侧声带治疗双侧声带麻痹老年患者一例，获得良好的呼吸及发声效果，报告如下。     

双侧声带麻痹的治疗进展

声带麻痹是多种疾病的常见症状,主要表现是部分或完全声带运动障碍,分为单侧声带麻痹和双侧声带麻痹,其中双侧声带麻痹临床症状为呼吸困难、误吸、声音嘶哑,严重时考虑气管切开术。随着手术方法的日益改进,声带麻痹的治疗效果有了进一步改善,但双侧声带麻痹仍然是一个复杂的临床问题,本文主要对目前双侧声带麻痹的治疗进展做一综述。     

Nd-YAG激光声带部分切除术治疗双侧声带麻痹

双侧声带麻痹的治疗方法较多,但疗效评说不一。我们1993～1995年应用Nd－YAG激光声带部分切除术治疗双侧声带麻痹4例,术后获得了喉通气改善和发声质量较满意。现报告如下。1资料与方法1．1一般资料4例中女2例,年龄分别为29岁、53岁;1例车祸致脑挫伤颅底骨折,昏迷1个月苏醒后拔除气管套管出现呼吸急促及喉鸣8月余;另1例3年前感冒后出现呼吸急促和喉鸣,稍活动伴呼吸困难。男2例,年龄分别为48岁、56岁,1例因甲状腺腺瘤,10年间先后3次手术,术后因呼吸困难共行4次气管切开术,最后1次已1年余;另1例为甲亢术后出现呼吸困难和声嘶3年…     

单侧声带麻痹的治疗（附32例报告）

本文用药物和手术方法治疗了３２例单侧声带麻痹。发现：６个月后大部分病例出现自身代偿，对未能代偿的病例进行手术治疗，行声带内移术６例，声带内注射术１例，神经肌蒂移植术２例，发音质量获得不同程度的改善。神经肌蒂移植术是治疗声带麻痹的理想办法。电起搏动态治疗单侧声带麻痹有待进一步研究。     

双侧声带麻痹的外科治疗

总结２７例双侧声带外展麻痹患者手术治疗的效果。全部病例在手术后均经１年以上的追踪。根据声带长短及甲状软骨前角角度大小的差异，采用了不同类型的手术方法。其中，行一侧构状软骨摘除声带外展术（Ｗｏｏｄｍａｎ术式）者１５例，术后声门裂最大径≥４ｍｍ者有８例，拔除气管插管者有１１例。对声带长度短、甲状软骨前角角度较小的患者，经喉裂开行改良半喉切除声门扩大术者共９例，其中８例术后声门裂达到４ｍｍ，并拔除了气管插管，但术后声音嘶哑较明显。另３例行环构后肌神经肌蒂移植术，无一例声门裂较术前扩大。这虽是保存发音和改善呼吸的一种生理性手术，但临床疗效难肯定，尚需改进。     

等离子射频辅助双侧声带后端切断术治疗双侧声带麻痹导致的上气道梗阻患者13例

目的 评估内镜下等离子射频辅助双侧声带后端切断术治疗双侧声带麻痹导致上气道梗阻患者的疗效.方法 回顾性分析13例双侧声带麻痹导致的上气道梗阻患者的病例资料,其中男6例、女7例,27～73岁,所有患者均接受等离子射频辅助双侧声带后端切断术.总结评估该手术的临床疗效.结果 13例随访时间1年1个月～2年11个月,所有患者无...     

等离子射频辅助双侧声带后端切断术治疗双侧声带麻痹导致的上气道梗阻患者13例

目的 评估内镜下等离子射频辅助双侧声带后端切断术治疗双侧声带麻痹导致上气道梗阻患者的疗效。 方法 回顾性分析13例双侧声带麻痹导致的上气道梗阻患者的病例资料,其中男6例、女7例,27~73岁,所有患者均接受等离子射频辅助双侧声带后端切断术。总结评估该手术的临床疗效。 结果 13例随访时间1年1个月~2年11个月,所有患者无严重并发症发生。一次拔管率为84.44%(10/13),二次手术拔管率为88.89%(11/13),拔管时间1~3个月,中位数1个月,上气道梗阻均未复发。 结论 内镜下等离子射频辅助双侧声带切断术操作简单、手术风险小,同时治疗双侧声带麻痹效果可靠,是双侧声带麻痹导致上气道梗阻的有效治疗方法之一,也可作为其他治疗失败的补救治疗措施。     

双侧声带水平切除治疗双侧声带癌

目的 探讨治疗双侧声带癌保留发声功能的手术治疗方法。方法 回顾性分析1990年1月～2001年8月行声带水平切除治疗的5例双侧声带癌患者的临床资料。根据UICC 1987 TNM分期标准，双侧T2NoMo1例，一侧T2NoMo，另一侧T1NoMo4例；病理诊断为鳞状细胞癌：行水平切除双侧声带及下半甲状软骨板，保留甲状软骨膜，上提环状软骨，将甲状软骨板外膜与环甲膜缝合，关闭术腔，周围用颈部带状肌缝合加固。结果 随访5年以上3例，1年以上2例。1例手术后5年死于肺癌，其它4例现仍生存。术后全部拔管，吞咽正常，声音低沉但可正常交谈。1例术后伤口感染，经治疗而愈。结论 声带水平切除治疗双侧声带癌可以一期切除肿瘤及周围受浸润组织，利用双侧室带代替声带发声，环状软骨上提形成支架建立呼吸通道，提高了术后生存质量。     

双侧声带膜样部后1/3切除术治疗双侧外展麻痹

198 9年 Dennis首先报道在支撑喉镜下用 CO2激光行双侧声带后份部分切除术治疗双侧声带外展麻痹。我们从 1 993年开始在支撑喉镜下 (或喉裂开 )通过电切或刀切双侧声带膜样部后 1 /3治疗 7例 ,获得了较好效果 ,现报告如下。1　资料与方法1 .1 　 临床资料7例患者中 ,6例为我院 1 993年 3月～ 1 998年1 0月的病例 ,病程均在 1 0个月以上 ,保守治疗无效 ;1例为我院帮助某院开展手术的病例 ,病程和保守治疗时间仅 2 0 d。其中 ,男 1例 ,女 6例 ;年龄 42～ 62岁 ,平均 48岁。 5例为甲状腺手术外伤所致 ,1例为肝硬化上消化道出血行三腔管压迫引…     

双侧声带麻痹的外科治疗

总结２７例双侧声带外展麻痹患者手术治疗的效果。全部病例在手术后均经１年以上的追踪。根据声带长短及甲状软骨前角角度大差异，采用了不同类型的手术方法。其中，行一侧杓状软骨摘除声带外展术（Ｗｏｏｄｍａｎ术式）者１５例，术后声门裂最大径＞４ｍｍ者有８例，拔除气管插管者有１１例。对声带长度短、甲状软骨前角角度较小的患者，经喉裂开行改良半喉切除声门扩大术者共９例，其中８例术后声门裂达到４ｍｍ，并拔除了气管插管     

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。     

Paradoxical vocal cord movement in newborn and congenital idiopathic vocal cord paralysis: two of a kind?

The second most common cause of stridor reported in the newborn is bilateral vocal cord paralysis (BVCP) and one-third of the cases have been categorized as idiopathic. During the last year four children with stridor since birth were referred to our department for examination. Videotaped flexible laryngoscopy, carried out with the patient awake or under general anaesthesia with a spontanous respiration, revealed instead of abduction of the vocal cords during inspiration, rather an active adductory movement. Consequently instead of BVCP, we made the diagnosis paradoxical vocal cord movement (PVCM). One of the twins required a tracheostomy, the three other patients have been observed without the need of further treatment. No previous publications have described PVCM in newborn. However, our observations and video recordings clearly show that the stridor in our four patients is due to PVCM. This is possibly the same condition as earlier reported as congenital, idiopathic BVCP where incoordinated vocal cord movement or dyskinesia has been a part of the laryngoscopic findings. The mechanism behind PVCM in this age group or site of lesion is unclear.     

A Study of incidence and etiopathology of vocal cord paralysis

Vocal cord paralysis is not a disease per se but is considered as a sign of underlying disease process that may be congenital or acquired, unilateral or bilateral, sudden or gradual in onset, and may occur at any age from cradle to the grave. This study vas carried out to know the incidence and etiopathology of vocal cord paralysis.The incidence was 0.42% or 42 per ten thousand new patients seen. Most patients presented in the 5th and 6th decades (77.2%). Males outnumbered females in the ratio of 3:1. The most common symptom of vocaL cord paralysis was hoarseness of voice alone(83.6%.).Onset of symptoms was gradual in 60% of cases.Left vocal cord was almost twice more commonly (61.9%)involved than the right one(38.1%).Idiopalhic group constituted 38.18% of patients followed by neoplaslic diseases 29.09oc.     

Laser arytenoidectomy in the treatment of bilateral vocal cord paralysis

The introduction of the CO2 surgical laser into laryngeal microsurgery has made resection of the posterior vocal cord together with the arytenoid cartilage possible. Since November 1990, 30 arytenoidectomies, 17 partial cordectomies and 18 bilateral cordectomies as described by Kashima were performed by means of a CO₂ laser in patients with bilateral paralyses of the vocal cords. In this group there were 58 women and 7 men. The patients’ ages ranged from 28 to 71 years (mean, 46.7 years). In one case the operation was performed twice: the right arytenoid cartilage was excised initially and the left arytenoid cartilage was removed in the second procedure. Three patients required tracheotomy before being transformed to the ENT Clinic, Poznañ. The etiologies of the vocal cord paralyses were complications arising from thyroid gland surgery (n = 62), trauma (n = 2) and excision of a bilateral glomus caroticum tumor. In all patients except one postoperative recovery was correct and no breathing difficulties were observed after extubation. In the one failure after operation endolaryngeal scar tissue resulted in glottic stenosis.     

新生儿双侧声带麻痹临床特点及预后分析

目的 探讨新生儿双侧声带麻痹的病因、临床特点、治疗及预后转归。 方法 对新生儿中心在2016年1月至2020年12月期间收治的双侧声带麻痹患儿进行回顾性分析,记录患儿的基本资料、病因、治疗情况及预后情况,并对患儿进行门诊及电话随访。 结果 共纳入28例患儿,男18例,女10例,年龄1~24 d,中位年龄3.5 d。92.9%(26/28)的患儿为足月儿,53.6%(15/28)的患儿为剖宫产。患儿首发症状主要为吸气性喉鸣及呼吸困难,占比高达78.6%(22/28),其次为呛奶及呕吐,占比为14.3%(4/28)。先天性双侧声带麻痹23例(82.1%,23/28),其中合并中枢神经系统病变7例(23.8%),先天性心脏病6例(21.4%),喉气管疾病6例(21.4%),胃食管反流疾病2例(7.1%);后天获得性声带麻痹5例(17.9%,5/28),获得性因素中多发于食管、气管疾病术后(80%,4/5)。全部患儿中8例(28.6%)行气管切开。所有患儿随访时间1个月~4年,死亡4例。气管切开患儿8例中,1例12个月时顺利拔管,1例堵管中,余5例目前随访16~47个月声带仍无恢复。观察等待20例患儿中,11例(64.7%)在后期随访的1~38个月内痊愈,声带活动恢复,6例(35.3%)在后期随访的5~17个月内声带活动改善,活动后喉鸣。 结论 新生儿双侧声带麻痹病因以先天性多见,共患病因素多,临床多表现为喉鸣及呼吸困难,部分有吞咽困难。气管切开术在新生儿双侧声带麻痹中并不是普遍必要的,多数先天性双侧声带麻痹患儿可自行恢复,预后较好,不要过早行外科手术干预。     

Ramsay—Hunt综合征并发同侧声带麻痹3例报告

我科于2011-10-2013-02共收治3例Ram-say-Hunt综合征并累及迷走神经患者,报告如下。1 病例报告例1男,55岁,因“左耳疼痛伴口角偏歪、左眼闭目不全5d”于2011年10月收入我科。专科检查：左侧耳甲腔内见多个呈簇集状排列、米粒般大小的淡红色水疱。     

支撑喉镜下CO2激光杓状软骨部分切除术治疗双侧声带麻痹的疗效分析

探讨支撑喉镜下CO₂激光杓状软骨部分切除治疗双侧声带麻痹的疗效。     

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。     

Laser arytenoidectomy in the management of bilateral vocal cord paralysis in children

Objective

To analyse the efficacy of CO₂ laser arytenoidectomy in the management of bilateral vocal cord paralysis in children.

Methods

Retrospective series of 17 patients who underwent laser arytenoidectomy for bilateral vocal cord between 1995 and 2008 in a tertiary care institution. All patients had bilateral laryngeal paralysis, in isolation (n = 5) or associated with concomitant airway conditions (n = 12). All cases had anterior prolapse of the arytenoids with partial obstruction of the airway on inspiration. 12/17 patients (70.5%) were tracheotomy-dependant, 2/17 were in-extubatable, and 3/17 had severe airway limitation, effort dyspnea and poor sleep pattern. Main outcome measures were decannulation rate for patients with tracheotomy, occurrence of aspiration and quality of voice.

Results

The mean age was 2.8 years old. 9/12 patients with tracheotomy (75%) were decannulated with a median delay of 2 months (2 days to 18 months). Both of the intubated patients were extubated with a median delay of 36 h. One of the decannulated patients who re-presented with a residual dyspnea after the arytenoidectomy was improved by a further laser cordotomy. 2/17 patients (11.7%) had post-operative persistent aspirations (with pneumopathies in one case), 5/17 patients were dysphonic, 3 improved with speech therapy and 2 with intracordal lipoinjection.

Conclusions

Laser arytenoidectomy is effective for improving the breathing in children presenting with a bilateral vocal fold paralysis associated with obstructive arytenoid prolapse. Results are good as a first-line surgery or following laryngo-tracheal surgery. Voice outcomes are satisfactory. However, aspiration is a rare complication.     

Combined glottographic measurement of vocal cord paralysis in the outpatient clinic

Recordings by combined glottography of vocal cord movements in patients with a vocal cord palsy were compared with a control group. In paralysis of the vocal cord the open quotient (OQ) is increased and the speed quotient (SQ) decreased. This system may have potential in the diagnosis and continued assessment of laryngeal abnormalities as well as providing a permanent objective record in medico-legal cases.