山东大学耳鼻喉眼学报 ›› 2015, Vol. 29 ›› Issue (3): 59-61.doi: 10.6040/j.issn.1673-3770.0.2015.174

• 论著 • 上一篇    下一篇

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

韩乃刚, 李晓红   

  1. 淄博市第一医院耳鼻咽喉头颈外科, 山东 淄博 255200
  • 收稿日期:2015-04-22 修回日期:2015-05-20 发布日期:2015-06-16
  • 通讯作者: 李晓红。E-mail:3233468725@qq.com E-mail:3233468725@qq.com
  • 作者简介:韩乃刚。E-mail:naigangh@163.com

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

HAN Naigang, LI Xiaohong   

  1. Department of Otolaryngology & Head and Neck Surgery, First Hospital of Zibo City, Zibo 255200, Shandong, China
  • Received:2015-04-22 Revised:2015-05-20 Published:2015-06-16

摘要: 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。

关键词: 杓状软骨切除, 低温等离子, 声带麻痹

Abstract: 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.

Key words: Arytenoidectomy, Coblation, Vocal fold paralysis

中图分类号: 

  • R767.4
[1] Bizakis J G, Papadakis C E, Karatzanis A D, et al. The combined endoscopic CO2 laser posterior cordectamy and total aryteaoidectomy for treatment of bilateral vocal cord paralysis[J]. Clin Ototmvngol Allied Sci, 2004, 29(1):51-54.
[2] 章薇, 屈季宁, 崔前波.病态嗓音主观评价与声学分析的相关性研究[J]. 听力学及言语疾病杂志, 2012, 20:544-546. ZHANG Wei, QU Jining, CUI Qianbo. A study of the correlation between pathological voice subjective evaluation and acoustic analysis[J]. J Audiol Speech Pathol, 2012, 20:544-546.
[3] 袁辉. 喉返神经麻痹的新概念与治疗进展[J]. 国外医学耳鼻咽喉科学分册, 2002, 26(5):273-279. YUAN Hui. The new concept of the laryngeal recurrent nerve paralysis, and treatment progress[J]. Foreign Med Arch Otolaryngol Sci, 2002, 26(5):273-279.
[4] 郭敏, 郑中立. 双侧声带麻痹的外科治疗[J]. 中华耳鼻咽喉科杂志, 1995, 30(3): 140-142. GUO Min, ZHENG Zhongli. Surgical treatment of bilateral vocal cord paralysis[J]. Chin J Otorhinolarynol, 1995, 30(3):140-142.
[5] 陈世彩, 郑宏良, 周水淼, 等. 双侧喉返神经损伤神经修复治疗术式探讨[J]. 听力学及言语疾病杂志, 2006, 14(4): 249-253. CHEN Shicai, ZHENG Hongliang, ZHOU Shuimiao, et al. Bilateral laryngeal recurrent nerve injury nerve repair treatment operation[J]. J Audiol Speech Pathol, 2006, 14(4): 249-253.
[6] Havas T E, Priestley K J. Laser tenotomy and vocal process resection for bilateral midline vocal fold fixation[J]. ANZ J Surg, 2003, 73(5):326-330.
[7] 杨怀安, 季文樾, 郭星, 等. 双声带中线位固定喉狭窄激光手术治疗成败原因探讨[J]. 临床耳鼻喉科杂志, 2006, 20(18):852-853 YANG Huaian, JI Wenyue, GUO Xing, et al. Bilingual middle line a fixed laryngostenosis laser surgery success or failure reasons[J]. J Clin Otolaryngol, 2006, 20(18):852-853.
[8] 黄冬雁, 王荣光, 杨仕明. 单侧杓状软骨加声带后部低温等离子射频消融术治疗双侧声带麻痹疗效分析[J]. 听力学及言语疾病杂志, 2014, 22(2):127-130. HUANG Dongyan, WANG Rongguang, YANG Shiming. Unilateral arytenoid cartilage and vocal cord at the back of the low temperature plasma radiofrequency ablation in the treatment of bilateral vocal cord paralysis curative effect analysis[J]. J Audiol Speech Pathol, 2014, 22(2):127-130.
[9] 张庆丰, 佘翠萍, 金屹峰, 等. 鼻内镜下低温等离子射频切除术治疗鼻咽血管纤维瘤的初步观察[J]. 中华耳鼻喉科杂志, 2010, 45(7):578-581. ZHANG Qingfeng, SHE Cuiping, JIN Yifeng, et al. Low-temperature plasma radiofrequency endoscopic resection of preliminary observation for the treatment of nasopharyngeal angiofibroma[J]. Chin J Otorhinolarynol, 2010, 45(7):578-581.
[10] 何本超, 徐必生, 颜风波, 等. 低温等离子射频消融术治疗早期声带癌[J]. 中国医师进修杂志, 2010, 33(33):70-71. HE Benchao, XU Bisheng, YAN Fengbo, et al. Low temperature plasma radiofrequency ablation treatment of early vocal cord carcinoma[J]. Chin J Physici Edu, 2010, 33(33):70-71.
[1] 田增华. 经鼻内镜鼻前庭囊肿去顶+低温等离子囊壁消隔术治疗鼻前庭囊肿42例临床观察[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 86-89.
[2] 仇书要,刘大波,钟建文,杨李强. 儿童阻塞性睡眠呼吸暂停低通气综合征等离子[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 34-37.
[3] 霍红,李五一,王剑,杨大海,金晓峰,田旭,牛燕燕. 等离子辅助悬雍垂腭咽成形术后重度咽狭窄的治疗[J]. 山东大学耳鼻喉眼学报, 2017, 31(6): 58-61.
[4] 张立庆,宋圣花,王愿,刘晓静,董伟达,周涵. 低温等离子刀、超声刀及传统方式行扁桃体切除术的术后两年随访比较[J]. 山东大学耳鼻喉眼学报, 2017, 31(5): 67-71.
[5] 张杰,陈雪梅,许安廷. 超声刀扁桃体切除术与低温等离子扁桃体切除术的对比研究[J]. 山东大学耳鼻喉眼学报, 2017, 31(5): 95-100.
[6] 尹娟,何颖瑶,郭鹤龄,肖旭平. 扁桃体Ⅰ度阻塞性睡眠呼吸暂停低通气综合征患儿不同等离子术式远期疗效[J]. 山东大学耳鼻喉眼学报, 2017, 31(3): 87-90.
[7] 刘俊茹,高英恺,杨杨,王俊菊,刘存军. 低温等离子刀切除舌根增生性肿物40例报告[J]. 山东大学耳鼻喉眼学报, 2017, 31(2): 83-84.
[8] 怀德,殷敏,张希龙,汪守峰,解成兰,徐敏,戴俊,蔡菁菁,曹影,金同爱,程雷. 低温等离子辅助改良腭咽成形联合舌减容和鼻腔扩容术对中重度OSAHS的近期疗效和安全性评价[J]. 山东大学耳鼻喉眼学报, 2017, 31(1): 50-54.
[9] 张立庆,杨翠方,周华群,陆美萍,董伟达. 低温等离子刀、超声刀及传统方式行扁桃体切除术的比较[J]. 山东大学耳鼻喉眼学报, 2016, 30(3): 56-60.
[10] 吕正华. 喉返神经减压术[J]. 山东大学耳鼻喉眼学报, 2016, 30(2): 17-19.
[11] 苗刚勇, 肖旭平, 谭志强. 低温等离子射频技术在婴幼儿甲状舌管囊肿手术中的应用[J]. 山东大学耳鼻喉眼学报, 2015, 29(6): 52-55.
[12] 张宝林, 郭睿, 龚维熙, 马坚凌, 李现龙. 软腭、舌根舌体低温等离子消融配合咽黏膜减张缝合治疗阻塞性睡眠呼吸暂停低通气综合征[J]. 山东大学耳鼻喉眼学报, 2015, 29(5): 19-22.
[13] 冯云, 杨大章, 吕秋萍, 刘丹丹, 王娜亚. 喉返神经修复术及非喉返神经修复术治疗声带麻痹[J]. 山东大学耳鼻喉眼学报, 2015, 29(3): 54-58.
[14] 王桂香, 张杰, 赵靖, 唐力行, 倪鑫. 婴幼儿舌根囊肿的诊断及围手术期治疗要点[J]. 山东大学耳鼻喉眼学报, 2015, 29(3): 62-64.
[15] 金永钢, 李建瑞, 张栋, 王宇, 柳宁宁, 钱海龙. 70°鼻内镜下低温等离子剥推融切术治疗儿童腺样体肥大[J]. 山东大学耳鼻喉眼学报, 2015, 29(2): 65-67.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!