单侧杓状软骨黏膜下次全切除并同侧声带外移治疗双侧声带外展麻痹

目的 探讨支撑喉镜下单侧杓状软骨黏膜下次全切除并同侧声带外移治疗双侧声带外展麻痹的适应证及临床意义.方法 支撑喉镜下对9例双侧声带外展麻痹伴呼吸困难的患者实施半导体激光(6例)或自制长针状单极电刀(3例)单侧杓状软骨次全切除术,然后利用穿刺针导入缝线于声带突后缘将声带拉向外侧,固定于甲状软骨上,其中8例为初次手术,1例为单侧杓状软骨激光部分切除术后失败病例.术后通过纤维喉镜检查患者声门的情况,并行发声质量主观评估.结果 9例患者中8例术后恢复了捕意的呼吸功能,其中3例发声质量无明显下降,5例声音质量较术前轻微下降,但不影响日常交流.术后7～14天8例即能全封管,观察至1～3个月拔管,平均拔管时间为45天.术后随访6～25个月,没有出现创面肉芽和再狭窄等并发症.1例(曾手术失败的病例)术后堵管失败,未能拔管,喉镜下见声门裂后端宽约2 mm.结论 支撑喉镜下单侧杓状软骨黏膜下次全切除并同侧声带外移可有效治疗双侧声带外展麻痹,方法简单易行,创伤小,拔管率高,患者的发声功能亦得到了满意的恢复和保留.     

低温等离子单侧声带离断并同侧杓状软骨切除术治疗双侧声带外展麻痹

目的 探讨在内镜支撑喉镜辅助下, 采用低温等离子消融刀头行单侧声带离断加同侧杓状软骨切除术治疗双侧声带外展麻痹的疗效。方法 对双侧声带外展麻痹的患者19例, 采用低温等离子消融术行单侧声带离断加同侧杓状软骨切除术进行治疗, 术后随访6～42个月, 分析评估该术式的临床效果。结果 19例术后呼吸功能恢复满意, 术后1个月内安全拔管18例, 其中术前已行气管切开8例。术后瘢痕挛缩喉腔狭窄未能拔管者1例, 经再次手术行对侧杓状软骨切除后成功拔管。嗓音评估发声效果满意14例, 轻微下降但患者能接受4例, 行2次手术者声嘶较前明显加重1例。结论 低温等离子单侧声带离断及同侧杓状软骨切除术治疗双侧声带外展麻痹, 术后呼吸困难完全缓解, 拔管率高, 发声功能保留良好。此术式创伤小, 术后愈合快, 安全、有效、微创。     

Nd:YAP激光杓状软骨切除术治疗双侧声带外展麻痹

目的 观察Nd：YAP激光杓状软骨切除术治疗双侧声带外展麻痹的疗效。方法2003年7月～2005年2月收治双侧声带麻痹患者9例，于支撑喉镜下应用Nd：YAP激光行右侧杓状软骨切除术，术前及术后3月以Dr．speech 4．0记录并分析嗓音频率微扰值（Jitter）、振幅微扰值（Shimmer）、标准声门噪声能量值（NNE）、最长声时（MPT）等4个主要参数，术后随访13-29月。结果 8例患者于术后1～3月拔管，1例于第二次手术后2月拔管。术后的噪声参数显示，Jitter与手术前相比差异无显著性意义（P≥0．05）；Shimmer、NNE、MPT等与手术前相比差异有显著性意义（P〈0．05）。结论 Nd：YAP激光杓状软骨切除术是治疗双侧声带外展麻痹的有效手段。     

成人杓状软骨切除术前后声门测量及嗓音分析

目的　探讨双侧声带麻痹激光杓状软骨切除满足拔管所需的最小声门面积 ,维持良好发音功能声门的最大面积。方法　 1998年 9月～ 2 0 0 3年 2月收治成人双侧声带麻痹 16例 ,在全身麻醉支撑喉镜显微镜下行激光右侧杓状软骨切除术。术前及术后 6～ 6 0个月行声门测量 (以 x±s表示测量结果 )及嗓音分析。结果　 15例拔管患者的术后声门最大开放面积为 (4 5 93± 6 5 6 )mm2 ,声门后部最大横径为 (4 97± 0 73)mm ,双侧声带最大夹角为 (2 4 34± 4 74 )°。嗓音声学参数显示手术前、后的基频微扰、振幅微扰、谐噪比差异无显著性意义 (P均 >0 0 5 ) ,而声门噪声能量、最大声时差异均有显著性意义 (P均 <0 0 5 )。拔管患者声门的最小面积为 38 0mm2 。随着声门面积增大 ,声门噪声能量增加 ,声门面积大于 5 0 1mm2 时 ,噪声能量增加更为明显。除外声门面积大于 5 0 1mm2的 3例患者 ,噪声能量手术前后差异无显著性意义。结论　杓状软骨切除治疗双侧声带麻痹拔除气管套管所需的最小声门面积为 38 0mm2 ,维持术前发音水平的最大声门面积为 5 0 1mm2 。     

内镜支撑喉镜下低温等离子杓状软骨切除术治疗双侧声带外展麻痹

目的 探讨内镜支撑喉镜下低温等离子杓状软骨切除术治疗双侧声带外展麻痹的可行性及效果.方法 回顾分析大连市中心医院耳鼻咽喉头颈外科2008年至2012年收治的29例双侧声带外展麻痹患者,均行内镜支撑喉镜下低温等离子单侧杓状软骨切除术.手术前后行声门测量及嗓音分析.结果 29例患者术后1周内均成功拔管.术前及术后3个月患者平均((x)±s,下同)声门面积为(21.9±4.7)mm2和(40.3±5.2)mm2,声门后部最大横径为(1.47 ±0.37) mm和(4.82±0.54)mm,差异均有统计学意义(t值分别为5.74和6.24,P值均＜0.05).术后3个月26例(89.7％)患者对嗓音质量表示满意.手术前后嗓音声学参数中基频、基频微扰、振幅微扰的差异均无统计学意义(P值均＞0.05);而最长发音时间差异有统计学意义(P＜0.05).随访3个月至3.5年,中位数2年,患者均无呼吸困难,可从事轻体力劳动.结论 内镜支撑喉镜下低温等离子杓状软骨切除术治疗双侧声带外展麻痹是一种安全、微创、有效的手术方式.     

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。     

单侧杓状软骨切除术联合同侧声带外移治疗双侧声带麻痹的疗效观察

目的 探讨单侧杓状软骨切除术联合同侧声带外移治疗双侧声带麻痹的临床疗效.方法 回顾分析2007年1月至2011年4月5例双侧声带麻痹患者的临床资料,所有患者均在全麻下行颈外径路单侧杓状软骨切除术联合同侧声带外移,观察术后临床效果和术前、术后6月患者的声学参数(基频-F0,基频微扰-jitter,振幅微扰-shimmer,标准化噪声能量-NNE和最长声时(MPT).结果 患者术后呼吸功能均显著改善,5例患者均成功1次拔管,平均拔管时间(18.67±4.83)d,发音质量无显著下降,术后随访6月无严重误吸、创面肉芽、再狭窄发生.术后6月患者的F0、jitter、shimmer、NNE显著降低,而MPT显著延长,P<0.05.结论 单侧杓状软骨切除术联合同侧声带外移治疗双侧声带麻痹临床效果好,无明显并发症,显著改善患者的声学参数和最大声时.     

红宝石激光同期杓状软骨内侧切除治疗双侧声带麻痹

目的 :探讨支撑喉镜下以红宝石激光同期切除双侧杓状软骨内侧治疗双侧声带麻痹的疗效。方法 :全部患者均行气管切开插管麻醉 ,以红宝石激光同期切除双侧杓状软骨的内侧。结果 :无手术并发症。全部患者随访 3～ 13个月 ,呼吸平稳 ,喉内无瘢痕粘连 ,发音明显好转 ,声门呼吸部较术前扩大≥ 4mm。结论 :以红宝石激光同期行双侧杓状软骨内侧切除治疗双侧声带麻痹是切实可行的。     

半导体激光杓状软骨次全切除治疗双侧声带麻痹

目的：探讨支撑喉镜下半导体激光杓状软骨次全切除治疗双侧声带麻痹的可行性。方法：气管切开，全麻支撑喉镜下，采用半导体激光接触式汽化方法一侧杓状软骨次切除，术中保留杓状软骨后外方约2mm的软骨外壳和声带膜部，治疗双侧声带麻痹的患者4例。结果：术后拔管时间分别为3天、一周和二周；术后随访分别为6、10、12、16个月，病人呼吸平稳，发音较满意。检查见杓状软骨次全切处粘膜光滑，无肉芽组织生长。结论：半导体激光杓状软骨次全切除治疗双侧声带麻痹，手术创伤轻，痛若小，操作简单，疤痕形成少，效果好，是治疗双侧声带麻痹理想的手术方法。     

半导体激光杓状软骨次全切除治疗双侧声带麻痹

目的：探讨支撑喉镜下半导体激光杓状软骨次全切除治疗双侧声带麻痹的可行性。方法：气管切开，全麻支撑喉镜下，采用半导体激光接触式汽化方法一侧杓状软骨次全切除，术中保留杓状软骨后外方约２ｍｍ的软骨外壳和声带膜部，治疗双侧声带麻痹的患者４例。结果：术后拔管时间分别为３天、一周和二周；术后随访分别为６、１０、１２、１６个月，病人呼吸平稳，发音较满意。检查见杓状软骨次全切处粘膜光滑，无肉芽组织生长。结论：半导体激光构状软骨次全切除治疗双侧声带麻痹，手术创伤轻，痛若小，操作简单，疤痕形成少，效果好，是治疗双侧声带麻痹理想的手术方法。     

成人杓状软骨切除术前后声门测量及嗓音分析

OBJECTIVE: To study minimal glottic area which can acquire sufficient airway for decannulation and maximal glottic area which can maintain preoperative vocal function on adult bilateral vocal cord paralysis with unilateral arytenoidectomy. METHODS: Sixteen adult received microscopic right arytenoidectomy with Diomed-25 laser under general anaesthesia and sustained laryngoscope from September 1998 to February 2003. The pre-postoperative glottic measurement and vocal acoustic parameters were analyzed. RESULTS: The postoperative maximal glottic area, maximal posterior glottic width and maximal opening angle between bilateral vocal cords of the 15 decannulated cases were (45.93 +/- 6.56) mm2, (4.97 +/- 0.73) mm and (24.34 +/- 4.74) degrees respectively. Compared with preoperative period, there were significant difference. Pre-postoperative acoustic parameters (Jitter, Shimmer, harmonics-noise ratio) were analyzed and no significant difference were found (P > 0.05, but there are significant difference in NNE (normalized noise energy) and MPT (maximum phonation time) (P < 0.05). Except for three cases whose postoperative glottic area were more than 50. 1 mm2, there were no significant difference in pre and postoperative NNE (P > 0.05). The minimal glottic area decannulated was 38.0 mm2. The more opening maximal glottic area, the greater of NNE because of bigger closing gap. Noticeable increase of NNE was observed when maximal opening glottic area was up to 50.1 mm2. CONCLUSIONS: The minimal glottic area for decannulation should be 38.0 mm2, and the maximal glottic area for maintaining preoperation vocal function should be 50.1 mm2 on adult bilateral voca cord paralysis with laser aryntenoidectomy.     

支撑喉镜下CO2激光杓状软骨切除术治疗双声带外展麻痹

目的　探讨支撑喉镜下CO2 激光显微杓状软骨切除术治疗双声带外展麻痹的手术方法、疗效和适应证。方法　 1994～ 1998年收治双声带外展麻痹患者 8例 ,其中 3例曾在外院经颈外进路手术失败 ,全部术前行气管切开术。参照并改良Ossoff窥镜下杓状软骨切除术 ,汽化杓状软骨前部 ,包括声带突和部分肌突 ,一小部分室带及声带后端 ,保留粘软骨膜并缝合切口 ,以消灭创面 ,双侧分次手术。结果　术后无肉芽滋生 ,无误吸 ,保留发音功能。 5例拔管 ,2例日间堵管、因睡眠时喉鸣未予拔管 ,1例等待对侧手术。随诊 6个月～ 3 5年。结论　本方式弥补了单纯窥镜及外科手术不足 ,如粘膜出血、水肿、操作困难等 ,而具备显微外科精细、准确的特点。术后反应轻微 ,保留发音功能。并可作为杓状软骨切除术或神经再支配手术失败后的补充手术     

支撑喉镜下CO2激光杓状软骨切除术治疗双声带外展麻痹

目的 探讨支撑喉镜下ＣＯ２激光显微杓状软骨切除术治疗双声带外展麻痹的手术方法、疗效和适应证。方法１９９４￣１９９８年收治双声带外展麻痹患者８例,其中３例曾在外院经颈外进路手术失败,全部术前行气管切开术。参照并改良Ｏｓｓｏｆｆ窥镜下杓状软骨切除术,汽化杓状软骨前部,包括声带突和部分肌突,一小部分室带及声带后端,保留粘软骨膜并缝合切口,以消灭创面,双侧分次手术。结果 术后无肉芽滋生,无误吸,保留发音功     

双侧声带麻痹不同术式治疗前后声门测量及嗓音评价

目的探讨3种不同的双侧声带麻痹治疗术后声门面积及嗓音质量。方法 46例双侧声带麻痹患者分别采用激光杓状软骨切除术(A 组24例),膈神经替代喉返神经吻合术(B 组9例),喉外径路杓状软骨切除声带外移固定术(C 组13例)治疗,手术前后行声门测量及嗓音分析。结果 A、B、C 组拔管率分别为91.7%(22/24)、88.9%(8/9)、100.0%(13/13),3种术式术后最大开放声门面积平均(x±s)分别为:(47.2±7.4)mm~2、(78.3±16.0)mm~2、(48.1±6.5)mm~2。B 组术后声门面积明显大于 A、C 组,差异有统计学意义(t 值分别为4.46和3.85,P 值分别为0.000和0.001)。A、C 组术后声门面积差异无统计学意义(t=1.68,P=0.101)。A 组术后17例能保持术前的嗓音质量,7例恶化;B 组术后5例嗓音好转,1例恢复正常,3例无变化;C 组术后3例嗓音无变化,10例恶化。B 组9例术后膈神经修复侧膈肌均麻痹不动,肺活量及最大呼吸容量为术前的72%～84%及76%～84%;半年后膈肌动度恢复达35%～76%,肺活量及最大呼吸容量为术前的93%～97%及91%～98%。结论膈神经替代吻合术后拔管患者声门面积最大,嗓音最好。激光杓状软骨切除和喉外径路杓状软骨切除声带外移固定术均能建市足够气道,拔除气管套管,但前者嗓音明显优于后者。     

Aerodynamic model of ventilation efficacy in patients after laser arytenoidectomy

The treatment of bilateral vocal cord paralysis presents a challenge to otolaryngologists. All surgical procedures are designed to widen the lumen of the glottis without impairing vocal function and laryngeal closure during swallowing and respiration. The aim of the study was to evaluate the effectiveness of the laser arytenoidectomy by our own method. Based on the analysis of the results of 36 patients operated on due to bilateral vocal cord paralysis the aerodynamic model of ventilation efficacy changes was introduced and then verified. On the basis of the study an increase of the cross-sectional area of the glottis after laser arytenoidectomy can be combined with air flow improvement in upper airways. Thanks to this relation the postoperative ventilation efficiency may be predicted on the basis of its preoperative value and geometrical parameters of the glottis.     

The assistance of coblation in arytenoidectomy for vocal cord paralysis

Background: There are many causes for vocal cord paralysis, which can cause difficulty in breathing in serious cases. The common surgical methods for solving vocal cord paralysis include laryngeal splitting or laser surgery, but there are limitations. Plasma radiofrequency ablation is a new treatment with good achievements in clinical applications.

Objective: To investigate the effect of coblation-assisted arytenoidectomy (CSA) in the treatment of bilateral vocal cord paralysis (BVCP).

Methods: All patients had undergone preoperative electrolaryngoscopic examination of the glottidis rima; electronic laryngoscopy can assess the width of the glottis. The purpose of preoperative electronic laryngoscopic evaluation is to assess the width of the glottis, and arytenoid cartilage movement. Unilateral arytenoid cartilage and a section of the vocal cords were removed in all cases.

Results: Of the 14 patients, 13 were successfully extubated after CSA; 1 patient could not be extubated and underwent a second CSA of the contralateral arytenoid cartilage, after which extubation was achieved. All patients were continuously followed up (6 months to 2 years), and all achieved satisfactory results.

Conclusions and significance: CSA can effectively relieve post-CSA dyspnea in patients with BVCP. More patients underwent tracheal cannula extubation after tracheotomy compared with other surgeries.     

Endoscopic laser arytenoidectomy for the treatment of bilateral vocal cord paralysis

Most patients with bilateral vocal cord paralysis have a fairly satisfactory voice, but their airway is usually compromised. The management of such patients presents a challenge to the otolaryngologist-head and neck surgeon. Numerous surgical procedures have been developed in an attempt to improve the patients's airway insufficiency without leaving him with a breathy, weak voice. Arytenoidectomy is currently the most reliable method of treating patients with bilateral vocal cord paralysis. Although both endoscopic and external approaches have been described for performing an arytenoidectomy, the endoscopic technique is more desirable since it requires no incision and theoretically allows for the immediate assessment of airway size. The addition of the CO2 laser to the surgical armamentarium offers certain refinements to the technique of endoscopic arytenoidectomy. Eleven patients with bilateral vocal cord paralysis of the larynx have been treated by endoscopic laser arytenoidectomy by the authors utilizing a technique developed by the two senior authors and subsequently taught to over 200 participants of the CO2 laser workshops sponsored by the Department of Otolaryngology-Head and Neck Surgery at Northwestern University Medical School; 10 of the 11 patients have been successfully decannulated. The technique and problems of this operation will be discussed.     

The influence of laser arytenoidectomy on ventilation parameters in patients with bilateral vocal cord paralysis

Bilateral vocal cord paralysis is a symptom that may lead to serious breathing problems. The treatment of patients with vocal cord paralysis presents a challenge to otolaryngologists. Many techniques have been developed in an attempt to improve the patient's airway insufficiency. The aim of the study was to evaluate the efficacy of the laser total unilateral arytenoidectomy with posterior cordectomy in patients with bilateral vocal cord paralysis. Thrity-six patients (33 females, 3 male) aged between 24 and 76 (mean 52) were treated by laser arytenoidectomy. The flow-volume loop and pletysmography were performed in all patients before and after the operation. Additionally, a group of 15 patients with unilateral vocal cord paralysis was introduced and analyzed as a special control. Based on the relative increase of the parameters after the surgery, the most useful of them were selected for the evaluation. Also, the character of the laryngeal obstruction was defined. Changes in the flow-volume loop before and after surgery were compared by planned comparison in univariate analysis ANOVA/MANOVA with an isolated control group. As the parameters AREA(EX), FEF50, FEF75, PEF and MMEF(75/25) increased most effectively, they appeared to be the most useful in the evaluation. FIV1/FEF1, FEF50/FIF50 and FEV1/FEV(0,5) allowed the definition of the obstruction as an extrathoracic dynamically variable quantity. The resistances measured during pletysmography diminished significantly after surgery. The introduction of the special control group with unilateral vocal cord paralysis showed that despite the significant improvement after surgery, the patients who had been operated on still had a laryngeal obstruction worse than that of patients from the control group. The laser arytenoidectomy is shown to be a useful and efficacious procedure for bilateral vocal cord paralysis.