电子喉镜吞咽功能检查在声带麻痹定位诊断中的应用

目的 探讨电子喉镜吞咽功能检查在声带麻痹定位诊断中的应用价值。方法 以15例单侧声带麻痹患者为例，应用电子喉镜对此组患者进行吞咽功能检查，其中左侧声带麻痹10例，右侧声带麻痹5例，发病期5d～10个月。以迷走神经神经节为界，将病变部位分为迷走神经神经节或以上部位的高位病变、迷走神经神经节以下部位的低位病变，其中高位病变4例，低位病变4例，部位不明7例。结果 高位病变组的4例患者，吞咽糊状食物时全部有食物残留于病变侧梨状窝；低位病变组的4例患者，吞咽糊状食物时3例梨状窝无食物残留，仅1例患者同侧梨状窝有食物残留，但是该例患者在同时进行的食管镜检查中发现食管中段癌；7例损伤部位不明的患者中，2例同侧梨状窝有食物残留，5例梨状窝无食物残留。结论 电子喉镜下对单侧声带麻痹患者进行吞咽功能检查，根据病变侧梨状窝有无食物残留可以初步判定喉返神经损伤的部位是在迷走神经节以上或以下部位。

Localization of vocal cord paralysis by electronic fibrolaryngoscopic swallowing study.

Objective To evaluate the application of electronic fibrolaryngoscopic swallowing study in the localiza- tion of vocal cord paralysis. Methods The electronic fibrolaryngoscopic swallowing study was conducted in 15 pa- tients with unilateral vocal cord paralysis. The duration of the disease varied from 5 days to 10 months. There were 5 cases of right side vocal cord paralysis and 10 cases of left side vocal cord paralysis. The lesions of vagus nerve were in the high level （at or above the ganglion of the vagus nerve） in 4 cases, low level （below the ganglion of the vagus nerve） in 4 cases, and unknown level in 7 cases. Results There was residual food in the pyriform sinus on the para- lysed side of the vocal cord in all the 4 cases with high-level vagus nerve damage, but only one case with low-level vagus nerve damage. Among the patients with unknown lesions of vagus nerve, residual food in the pyriform sinus on the impaired side of the vocal cord was found in 2 cases but not in another 5 cases. Conclusion The impaired site of the vagus nerve can be possibly determined according to whether or not there was residual food in the pyriform sinus on the impaired side of the unilateral vocal cord paralysis.