喉返神经修复术及非喉返神经修复术治疗声带麻痹

目的 探讨喉返神经修复术及非喉返神经修复术这两种不同术式治疗声带麻痹的疗效。方法 ①单侧声带麻痹21例, 其中采用喉返神经修复术(喉返神经减压术、颈袢神经与喉返神经吻合术、颈袢神经肌肉蒂环杓侧肌移植术)15例, 采用非喉返神经修复术(声带自体脂肪注射术、自体软骨Ⅰ型甲状软骨成形术)6例;②双侧声带麻痹16例, 其中采用喉返神经修复术(喉返神经减压术、颈袢神经肌肉蒂环杓后肌移植术)6例, 采用非喉返神经修复术(声带外移术、内镜下杓状软骨切除术)10例。治疗前后以电子喉镜、频闪喉镜、声音评估等评价手术疗效。结果 ①单侧喉返神经麻痹患者中喉返神经修复组15例, 术后术侧声带活动不同程度改善, 发音时声带突明显内收, 声带振动及黏膜波均恢复对称性, 声门闭合良好, 手术前后的最大声时为(5.51±1.05)s和(12.10±1.41)s, 差异有统计学意义(P<0.01);非喉返神经修复术术后声带均不同程度内移, 声嘶症状改善, 但声带均无运动, 手术前后的最大声时为(5.47±0.45)s和(11.83±1.47)s, 差异有统计学意义(P<0.01)。神经修复组和非神经修复组术后最大声时比较, 差异无显著性意义(P>0.05);②双侧喉返神经麻痹患者中喉返神经修复术6例中, 术后呼吸困难缓解及声带外展部分恢复4例;非神经修复术10例术后呼吸困难改善;神经修复组术后拔管率为66.7%, 非神经修复组术后拔管率为100%;Fisher精确概率法比较两组术后拔管率, 差异无统计学意义(P>0.05)。结论 对于单侧声带麻痹, 喉返神经修复术及非喉返神经修复术疗效相当, 前者的远期疗效更佳。对于双侧声带麻痹, 非喉返神经修复术疗效更佳, 但喉返神经修复术不影响患者的发音功能。选择喉返神经修复术或非喉返神经修复术治疗声带麻痹, 需要医师根据自身的专业知识及技能、患者的身体状况及需求, 作出慎重的决定, 以取得可靠的疗效。

Reinnervation vesus non-reinnervation surgery for vocal fold paralysis

Objective To compare the efficacy of reinnervation and non-reinnervation surgery in the treatment of vocal cord paralysis (VCP). Methods ① Of the 21 cases of unilateral vocal cord paralysis (UVCP), 15 were treated with reinnervation (recurrent laryngeal nerve decompression, anastomosis of ansa cervicalis nerve and recurrent laryngeal nerve, anastomosis of end to end of recurrent laryngeal nerve, nerve muscular pedicle technique to lateral cricoarytenoid muscle), and 6 were treated with non-reinnervation (vocal cord autologous fat injection, type Ⅰ thyroplasty using autologous cartilage). ② Of the 16 cases of bilateral vocal cord paralysis (BVCP), 6 were treated with reinnervation (recurrent laryngeal nerve decompression, bilateral nerve muscular pedicle technique to posterior cricoarytenoid muscle), and 10 were treated with non-reinnervation (vocal cord lateralization, endoscopic resection of arytenoid). The therapeutic effects were evaluated with fiber laryngoscope, strobe laryngoscope, and voice assessment. Results ① Of the 15 UVCP cases treated with reinnervation, vocal cord regained different degrees of movement and adduction when pronunciating. Vocal cord vibration and mucosal wave regained symmetry, and glottal closure was good. MPT before and after surgery was 5.51±1.05 and 12.10±1.41 seconds (P<0.01). Of the 6 UVCP cases treated with non-reinnervation treatment, hoarseness symptoms were improved, but there was no movement of the vocal cords. MPT before and after surgery was 5.47±0.45 and 11.83±1.47 seconds (P<0.01). The difference between MPT of reinnervation and non-reinnervation surgery was not statistically significant (P>0.05). ② Of the 6 BVCP cases treated with reinnervation, 4 had partial vocal cord abduction restored and dyspnea was relieved. Of the 10 BVCP cases treatedwith non-innervation surgery, dyspnea was relieved. Decannulated rate of cases treated with reinnervation and non-reinnervation was 66.7% (4/6) and 100% (10/10), respectively. The difference between the two groups was not statistically significant as analyzed with Fisher exact test (P>0.05). Conclusion Reinnervation and non-reinnervation surgery have considerably good therapeutic effects on UVCP, and the former has a better long-term efficacy. In BVCP, non-reinnervation has better therapeutic effect than reinnervation, but the latter can maintain voice quality. Surgical treatment should be chosen based on surgeons’ expertise, and patients’ physical condition and needs.