山东大学耳鼻喉眼学报 ›› 2018, Vol. 32 ›› Issue (6): 18-21.doi: 10.6040/j.issn.1673-3770.1.2018.024

• 论著 • 上一篇    下一篇

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

刘大昱(),孙睿杰*(),李学新,姜震,岳建林,林云,雷大鹏,潘新良   

  1. 山东大学齐鲁医院耳鼻咽喉科, 国家卫生健康委员会耳鼻咽喉科学重点实验室, 山东 济南 250012
  • 收稿日期:2018-10-15 出版日期:2018-11-20 发布日期:2018-11-29
  • 通讯作者: 孙睿杰 E-mail:entldy@aliyun.com;sunrj27@yahoo.com.cn
  • 作者简介:刘大昱。E-mail：entldy@aliyun.com，刘大昱，医学博士，副教授，硕士生导师，山东大学齐鲁医院耳鼻咽喉科副主任、山东大学齐鲁医院(青岛)耳鼻咽喉头颈外科常务副主任。现任中华医学会耳鼻咽喉头颈外科分会青年委员、山东省医学会耳鼻咽喉科学分会青年委员会副主任委员，山东省医师协会耳鼻咽喉头颈外科分会常务委员，山东中西医结合学会耳鼻咽喉科分会委员，山东中医药学会耳鼻咽喉专业委员会委员等。擅长喉癌、下咽癌、甲状腺癌、颈段食管癌等各种头颈部恶性肿瘤的手术切除和功能重建，在咽喉显微外科领域经验丰富，有独到研究。在国内外期刊发表学术论著20余篇。主持参与山东省多项课题及国家自然科学基金项目，并获得多项省部级奖项。

Therapeutic effect of partial laryngectomy with CO2 laser in the treatment of bilateral vocal cord paralysis

Dayu LIU(),Ruijie SUN*(),Xuexin LI,Zhen JIANG,Jianlin YUE,Yun LIN,Dapeng LEI,Xinliang PAN   

  1. Department of Otorhinolaryngology, Qilu Hospital of Shandong University, NHC Key Laboratory of Otorhinolaryngology, Jinan 250012, Shandong, China
  • Received:2018-10-15 Online:2018-11-20 Published:2018-11-29
  • Contact: Ruijie SUN E-mail:entldy@aliyun.com;sunrj27@yahoo.com.cn

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摘要： 目的

探讨支撑喉镜下CO2激光杓状软骨部分切除治疗双侧声带麻痹的疗效。

方法

回顾分析2010年1月至2017年6月期间诊断为双侧声带麻痹，并在山东大学齐鲁医院耳鼻咽喉科接受支撑喉镜CO2激光杓状软骨部分切除术患者26例，统计患者的拔管率、术后拔管时间、手术次数、住院时间、并发症发生率。评价支撑喉镜CO2激光切除声带后部及部分杓状软骨切除术的疗效。

结果

所有患者均于术后5~10 d出院。吞咽功能恢复率100%，无喉部水肿窒息、严重误吸、严重出血并发症。拔管率88%，拔管时间为术后2~25个月；再手术率36%，9例中1例接受3次手术。主观嗓音较术前无实质性下降者为52%(13/25)。拔管患者中21例自觉日常生活及轻度运动无呼吸困难。

结论

支撑喉镜CO2激光杓状软骨部分切除术具有创伤小、术后恢复快、并发症发生率低，兼顾呼吸改善和嗓音、吞咽功能保护的优点，疗效确切，是治疗双侧声带麻痹的可靠术式。提高术后拔管率的关键在于控制手术区肉芽组织及瘢痕的生长。

关键词: 双侧声带固定, 喉返神经麻痹, CO2激光

Abstract: Objective

To evaluate the effect of endoscopic carbon dioxide laser partial arytenoidectomy in the treatment of bilateral vocal cord paralysis.

Methods

Twenty-six patients diagnosed with bilateral vocal cord paralysis and hospitalized at the Qilu Hospital of Shandong University to undergo endoscopic carbon dioxide laser partial arytenoidectomy between January 2010 and June 2017 were included in this retrospective study. And evaluate the decannulation rate, hospitalization time, times of surgery, complication rate.

Results

All patients were discharged from the hospital within 7 to 10 days after surgery following satisfactory recovery of their swallowing function. No severe laryngeal edema, aspiration, apnea, and/or bleeding were observed in the postoperative period. The rate of decannulation was 88%, while the re-intervention rate was 36%. 52% of the patients did not perceive any considerable impairment in their voice quality compared to pre-operative voice quality.

Conclusion

Endoscopic carbon dioxide laser posterior cordectomy and partial arytenoidectomy is a reliable method for the treatment of bilateral vocal cord paralysis. The key factor for improving the rate of decannulation is regulating the formation of granulation tissue and scars.

Key words: Bilateral vocal cord paralysis, Recurrent laryngeal nerve paralysis, CO2 laser

中图分类号: 

  • R767

图1

术中电子喉镜照片"

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