半导体激光单侧声带手术治疗双侧声带麻痹

目的 研究支撑喉镜下半导体激光杓状软骨部分切除及声带膜部后1／2切除术或喉内肌插入式照射术治疗双侧声带外展麻痹的效果。方法 双侧声带麻痹患者12例，气管切开插管，全麻，在支撑镜下采用两种方法行半导体激光手术，一种方法为切除一侧部分杓状软骨及声带膜部后1／2，治疗9例；另一种方法为切除包括声带突的部分杓状软骨，在声带突外方不同点插入式照射喉内肌，使声门裂后方横径达5mm以上，治疗3例。结果 术后随访7个月至8年，10例成功拔管；2例患者因瘢痕体质导致喉内、气管内肉芽组织生长而未拔管。结论 支撑喉镜下半导体激光治疗双侧声带麻痹，手术创伤轻，出血少，操作简便，术后拔管率高，对气道及发音功能影响较小，并发症较少，是治疗双侧声带麻痹的微创手术方法。

Treatment of Bilateral Vocal Cord Paralysis with Endoscopic Semiconductor Diode Laser

Objective To investigate the clinical effect of semiconductor diode laser(SCDL)for the treatment of bilateral vocal cord paralysis. Methods Endolaryngeal unilateral part of arytenoid and vocal cord resection(9 cases)or only arytenoid resection(3 cases) and intrinsic laryngeal muscles irradiation using SCDL were performed in 12 patients with bilateral vocal cord paralysis.The glottic fissure in the posterior portion of the vocal cord was enlarged to about 5mm. Results The 10 of 12 previously tracheostomized patients were decannulated after one step operation.One patient underwent two-step surgery,and decannulated 6 months after second operation.All patients above showed respiratory improvement and voice quality of the latter method was superior to the former one.Two patients could not decannulated because of endolaryngeal and tracheal stenosis due to granulation and scar. Conclusions Transoral SCDL arytenoidectomy seems to be a reliable and effective minimally invasive procedure for airway and voice restoration and can replace more invasive surgical interventions.