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。

Coblation unilateral vocal cord transection with arytenoidenctomy in the treatment of bilateral vocal cord paralysis

Objective To evaluate the clinical efficacy of endoscopic coblation unilateral vocal cord transection with arytenoidectomy for the treatment of bilateral vocal cord paralysis. Methods A total of 19 patients with bilateral vocal cord paralysis received unilateral vocal cord transection and arytenoidectomy using coblation under video suspension laryngoscope. During the follow-up of 6 to 42 months, the curative effects were analyzed. Results Decannulation was performed in 18 cases 1 month postoperatively, 8 of which had undergone tracheotomy before operation. Decannulation failed in 1 case due to dyspnea caused by scar diathesis, and then succeeded after the contralateral arytenoid was removed. Of all 19 cases, 14 achieved satisfactory vocal effects, 4 had acceptable vocal effects, and 1 case had worse trachyphonia. Conclusion Safe and minimally invasive, endoscopic coblation assisted vocal cord transection and arytenoidectomy is an effective treatment for bilateral abductor paralysis. It has a high decannulated rate while the voice quality remains satisfying.