等离子射频辅助双侧声带后端切断术治疗双侧声带麻痹导致的上气道梗阻患者13例

doi:10.6040/j.issn.1673-3770.1.2020.098

摘要/Abstract

摘要： 目的评估内镜下等离子射频辅助双侧声带后端切断术治疗双侧声带麻痹导致上气道梗阻患者的疗效。方法回顾性分析13例双侧声带麻痹导致的上气道梗阻患者的病例资料,其中男6例、女7例,27~73岁,所有患者均接受等离子射频辅助双侧声带后端切断术。总结评估该手术的临床疗效。结果 13例随访时间1年1个月~2年11个月,所有患者无严重并发症发生。一次拔管率为84.44%(10/13),二次手术拔管率为88.89%(11/13),拔管时间1~3个月,中位数1个月,上气道梗阻均未复发。结论内镜下等离子射频辅助双侧声带切断术操作简单、手术风险小,同时治疗双侧声带麻痹效果可靠,是双侧声带麻痹导致上气道梗阻的有效治疗方法之一,也可作为其他治疗失败的补救治疗措施。

关键词: 双侧声带麻痹, 双侧声带后端切断术, 等离子射频, 拔管率

Abstract: Objective To evaluate the efficacy of the endoscopic plasma radiofrequency assisted bilateral posterior partial transverse cordotomy in patients with upper airway obstruction due to bilateral vocal cord paralysis. Methods Clinical data of 13 patients with upper airway obstruction caused by bilateral vocal cord paralysis was retrospectively analyzed, including 6 males and 7 females, aged 27-73 years. All patients underwent endoscopic plasma radiofrequency assisted bilateral posterior partial transverse cordotomy, to summarize and evaluate clinical effect of this operation. Results The follow-up period was from 1 year 1 month to 2 years 11 months, and no serious complications occurred in all the patients. A one-step successful decannulation was achieved in 84.44%(10/13), a two-step successful decannulation was achieved in 88.89%(11/13). Decannulation time was1-3 months, and the median decannulation time was 1 month.There was no recurrence of upper airway obstruction. Conclusion Endoscopic bilateral posterior partial transverse cordotomy can establish a reliable and effective airway and maximize the retention of swallowing and voice functions. At the same time, it is a safe, reliable, simple and minimally invasive treatment option.

Key words: Bilateral vocal cord paralysis, Bilateral posterior partial transverse cordotomy, Plasma radiofrequency, Decannulation rate

中图分类号:

R767.4

赵晶,李进让,郭红光. 等离子射频辅助双侧声带后端切断术治疗双侧声带麻痹导致的上气道梗阻患者13例[J]. 山东大学耳鼻喉眼学报, 2021, 35(2): 39-45.

ZHAO Jing, LI Jinrang, GUO Hongguang. Plasma radiofrequency assisted bilateral posterior partial transverse cordotomy in the treatment of 13 patients with upper airway obstruction caused by bilateral vocal cord paralysis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(2): 39-45.

参考文献

[1] Dennis DP, Kashima H. Carbon dioxide laser posterior cordectomy for treatment of bilateral vocal cord paralysis[J]. Ann Otol Rhinol Laryngol, 1989, 98(12 Pt 1): 930-934. doi:10.1177/000348948909801203.
[2] Ossoff RH, Sisson GA, Duncavage JA, et al. Endoscopic laser arytenoidectomy for the treatment of bilateral vocal cord paralysis[J]. Laryngoscope, 1984, 94(10): 1293-1297. doi:10.1288/00005537-198410000-00006.
[3] Oysu C, Toros SZ, Tepe-Karaca Ç, et al. Endoscopic posterior cordotomy with microdissection radiofrequency electrodes for bilateral vocal cord paralysis[J]. Otolaryngol Head Neck Surg, 2014, 150(1): 103-106. doi:10.1177/0194599813513425.
[4] Basterra J, Castillo-Lopez Y, Reboll R, et al. Posterior cordotomy in bilateral vocal cord paralysis using monopolar microelectrodes and radiofrequency in 18 patient[J]. Clin Otolaryngol, 2018, 43(1): 340-343. doi:10.1111/coa.12940.
[5] 张庆泉, 陈秀梅, 王永福, 等. 彭氏电刀一侧声带后部及声带突切除治疗双侧声带麻痹八例疗效观察[J]. 中华耳鼻咽喉头颈外科杂志, 2016, 51(12): 939-940. doi:10.3760/cma.j.issn.1673-0860.2016.12.012. ZHANG Qingquan, CHEN Xiumei, WANG Yongfu, et al. Evaluation of 8 cases of bilateral vocal cord paralysis by the resection of posterior part of vocal cord and vocal process using PMOD[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2016, 51(12): 939-940. doi:10.3760/cma.j.issn.1673-0860.2016.12.012.
[6] 李进让,赵晶. 双侧声带麻痹诊断及治疗进展[J]. 中华耳鼻咽喉头颈外科杂志, 2020,55(11): 1080-1085. doi: 10.3760/cma.j.cn115330-20200706-00559 Li J R, Zhao, J. Progress in diagnosis and treatment of bilateral vocal cord paralysis[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery. 2020,55(11):1080-1085. doi:10.3760/cma.j.cn115330-20200706-00559.
[7] Bajaj Y, Sethi N, Shayah A, et al. Vocal fold paralysis: role of bilateral transverse cordotomy[J]. J Laryngol Otol, 2009, 123(12): 1348-1351. doi:10.1017/S0022215109990983.
[8] Wang S, Zhou S, Xu Y. Cordotomy for bilateral cord abductal paralysis[J]. Chin Med J(Engl), 2001, 114(5): 542-543.
[9] 李进让, 郭红光, 孙建军. 声带后端切开术[J]. 中国耳鼻咽喉头颈外科, 2011,18(8): 445-447. doi:10.16066/j.1672-7002.2011.08.018. LI Jinrang, GUO Hongguang, SUN Jianjun. Posterior cordotomy for bilateral paralysis of the vocal cord[J]. Chin Arch Otolaryngol-Head Neck Surg, 2011,18(8): 445-447. doi:10.16066/j.1672-7002.2011.08.018.
[10] Lawson G, Remacle M, Hamoir M, et al. Posterior cordectomy and subtotal arytenoidectomy for the treatment of bilateral vocal fold immobility: functional results[J]. J Voice, 1996, 10(3): 314-319. doi:10.1016/s0892-1997(96)80013-0.
[11] 刘大昱, 孙睿杰, 李学新, 等. 支撑喉镜下CO₂激光杓状软骨部分切除术治疗双侧声带麻痹的疗效分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(6): 18-21. doi:10.6040/j.issn.1673-3770.1.2018.024. LIU Dayu, SUN Ruijie, LI Xuexin, et al. Therapeutic effect of partial laryngectomy with CO₂ laser in the treatment of bilateral vocal cord paralysis[J]. J Otolaryngol Ophthalmol Shandong Univ, 2018, 32(6): 18-21. doi:10.6040/j.issn.1673-3770.1.2018.024.
[12] 韩乃刚, 李晓红. 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[J]. 山东大学耳鼻喉眼学报, 2015(3): 59-61. doi:10.6040/j.issn.1673-3770.0.2015.174. HAN Naigang, LI Xiaohong. Coblation unilateral vocal cord transection with arytenoidenctomy in the treatment of bilateral vocal cord paralysis[J]. J Otolaryngol Ophthalmol Shandong Univ, 2015(3): 59-61. doi:10.6040/j.issn.1673-3770.0.2015.174.
[13] Shvero J, Koren R, Stern Y, et al. Laser posterior ventriculocordectomy with partial arytenoidectomy for the treatment of bilateral vocal fold immobility[J]. J Laryngol Otol, 2003, 117(7):540-543. doi: 10.1258/002221503322112969.
[14] Aubry K, Leboulanger N, Harris R, et al. Laser arytenoidectomy in the management of bilateral vocal cord paralysis in children[J]. Int J Pediatr Otorhinolaryngol,2010, 74(5):451-455. doi: 10.1016/j.ijporl.2010.01.019.

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