两种手术方法治疗双侧声带神经麻痹

目的 通过观察经喉外进路及经支撑喉镜下行CO2激光手术切除杓状软骨治疗双侧声带神经麻痹的疗效,对比两种手术方法的优缺点,择优选取合适的术式。方法 对双侧喉返神经致喉狭窄的13例术后患者进行随访,其中7例行喉外进路杓状软骨切除术声带外展固定,6例行经支撑喉镜下行CO2激光手术切除杓状软骨,13例术前均已行气管切开,术后随访6个月至2年。结果 采用喉外进路杓状软骨切除术声带外展固定7例,术后1次拔管3例,2次拔管2例;采用经支撑喉镜下行CO2激光手术切除杓状软骨6例,术后1次拔管4例,2次拔管1例。结论 两种手术方法各有优缺点。     

CO2激光单侧杓状软骨次全切除术治疗双侧外展性声带麻痹

目的　探讨CO2 激光单侧杓状软骨次全切除术治疗双侧外展性声带麻痹手术的适应证及临床意义。方法　支撑喉镜下对 8例双侧外展性声带麻痹伴呼吸困难的患者实施了CO2 激光单侧杓状软骨次全切除术和手术创面黏膜吻合术。其中 ,继发于双侧甲状腺切除术 5例 ,外伤所致双侧外展性声带麻痹 2例 ,原因不明 1例。术前接受气管造口术 5例 ,气管切开术 1例。术后通过纤维喉镜检查患者新建声门裂的通气情况 ,发音质量主观评估由患者本人和医疗小组共同完成。结果8例患者术后均恢复了满意的呼吸功能 ,发音质量均无明显下降 ,平均气管套管拔除时间为 44 2d。术后随访 5～ 43个月 ,没有出现误吸和再狭窄等并发症。结论　支撑喉镜下CO2 激光单侧杓状软骨次全切除术和创面黏膜吻合术简单易行 ,创面小 ,术后愈合快 ,可避免肉芽组织增生和瘢痕形成所导致的声门区再狭窄 ,患者的呼吸和发音功能均得到了满意的恢复和保留     

颈侧进路内镜下喉外单侧杓状软骨次全切除术治疗双侧外展性声带麻痹

目的：探讨提高治疗双侧外展性声带麻痹疗效的手术方法。方法：对13例双侧外展性声带麻痹伴呼吸困难的患者，行气管切开插管、全麻，经颈侧进路内镜下实施喉外单侧杓状软骨次全切除术。结果：手术过程均顺利，术后均未放置扩张子；呼吸和发声功能均恢复满意；拔管时间为8～15d，平均11．5d；术后随访6～36个月，未出现再狭窄、发声质量下降及呼吸困难等并发症。结论：该手术操作简单，术中对声门裂的可控性好，对喉黏膜无损伤，无需放置喉内扩张子；术后喉功能恢复快而满意，是治疗双侧外展性声带麻痹的较好术式。     

CO2 laser endoscopic subtotal arytenoidectomy for bilateral median vocal cord paralysis]

OBJECTIVE: To delineate the surgical procedures and correlated techniques for endoscopic subtotal arytenoidectomy, as well as to discuss their applications and clinical outcomes. METHODS: CO2 Laser endoscopic unilateral arytenoidectomy was performed in eight cases of bilateral median vocal cord paralysis combined with one stage of mucosal micro-anastomosis. All patients suffered from dyspnea in some extent, of which 5 had the history of thyroidectomy and 2 had traumatic causes following esophagectomy and tracheal surgery respectively. One of patient had unknown cause. Six patients had undergone tracheotomy prior to operation or before their referral to our hospital. The airway was evaluated via fibro-optic laryngoscopy, and the voice quality was assessed subjectively by the patients and the surgeon before and after surgery. RESULTS: Following 5-43 months after the surgery, in all cases the function of airway as well as the acceptable voice quality was successfully restored. The tracheotomy done before operation in six patients was decannulated within the mean time of 44.2 days post-operation. CONCLUSION: The endoscopic approach for CO2 laser unilateral arytenoidectomy may lead to better restoration of an adequate airway and satisfying phonation without postoperative aspiration. Mucosal micro-anastomosis can prevent the formation of granulation or scar tissue thus promotes the healing processes. This procedure is simpler than other ordinary surgical methods, and could be a satisfactory alternation of treatment for bilateral median vocal cord paralysis.     

The combined endoscopic CO2 laser posterior cordectomy and total arytenoidectomy for treatment of bilateral vocal cord paralysis

The combined endoscopic CO₂ laser posterior cordectomy and total arytenoidectomy for treatment of bilateral vocal cord paralysis Upper airway obstruction, because of bilateral vocal cord paralysis, presents a serious challenge to the Otolaryngologist. Various surgical techniques have been advocated for the management of patients with vocal cord paralysis. Among these techniques, the individual use of laser CO₂ arytenoidectomy and posterior cordotomy has gained wide acceptance. In this report, we describe our experience in the management of bilateral vocal cord paralysis by combining posterior partial cordotomy as described by Dennis and Kashima, with total arytenoidectomy as described by Ossoff et al. We report the long‐term results in the management of 18 patients treated in our department during the last 8 years.     

The combined endoscopic CO(2) laser posterior cordectomy and total arytenoidectomy for treatment of bilateral vocal cord paralysis

Upper airway obstruction, because of bilateral vocal cord paralysis, presents a serious challenge to the Otolaryngologist. Various surgical techniques have been advocated for the management of patients with vocal cord paralysis. Among these techniques, the individual use of laser CO(2) arytenoidectomy and posterior cordotomy has gained wide acceptance. In this report, we describe our experience in the management of bilateral vocal cord paralysis by combining posterior partial cordotomy as described by Dennis and Kashima, with total arytenoidectomy as described by Ossoff et al. We report the long-term results in the management of 18 patients treated in our department during the last 8 years.     

The role of endoscopic laterofixation of the vocal cord in the treatment of bilateral abductor paralysis.

Different techniques were compared in management of 36 patients with bilateral abductor paralysis of the vocal cords. Ten patients were treated by microsurgical arytenoidectomy through a mid-line thyrotomy, with successful decannulation in only three. Fifteen patients were treated by endolaryngeal microsurgical arytenoidectomy, with failure to decannulate four cases. The procedure of endoscopic laterofixation of the vocal cord was used to treat 11 patients. Ten patients had an adequate long-lasting airway with a socially acceptable voice function. One patient had a revision surgery and was successfully decannulated. The technique was found to be a reliable option in the management of bilateral abductor paralysis. It is a modifiable procedure with a feasibility to adjust the position of the vocal cord under endoscopic control. It can be combined with endolaryngeal arytenoidectomy if the gain in the airway size produced by laterofixation is found insufficient.     

支撑喉镜下CO2激光杓状软骨切除术治疗双声带外展麻痹

目的　探讨支撑喉镜下CO2 激光显微杓状软骨切除术治疗双声带外展麻痹的手术方法、疗效和适应证。方法　 1994～ 1998年收治双声带外展麻痹患者 8例 ,其中 3例曾在外院经颈外进路手术失败 ,全部术前行气管切开术。参照并改良Ossoff窥镜下杓状软骨切除术 ,汽化杓状软骨前部 ,包括声带突和部分肌突 ,一小部分室带及声带后端 ,保留粘软骨膜并缝合切口 ,以消灭创面 ,双侧分次手术。结果　术后无肉芽滋生 ,无误吸 ,保留发音功能。 5例拔管 ,2例日间堵管、因睡眠时喉鸣未予拔管 ,1例等待对侧手术。随诊 6个月～ 3 5年。结论　本方式弥补了单纯窥镜及外科手术不足 ,如粘膜出血、水肿、操作困难等 ,而具备显微外科精细、准确的特点。术后反应轻微 ,保留发音功能。并可作为杓状软骨切除术或神经再支配手术失败后的补充手术     

双声带楔形切除术治疗双侧声带外展麻痹

目的：探讨治疗双侧声带外展麻痹的微创外科手术方式——显微支撑喉镜下CO2激光双声带楔形切除术的临床应用价值。方法：使用显微支撑喉镜激光手术系统，治疗4例双侧声带外展麻痹患者。结果：3例经过1次手术，1例经过2次手术，随访5-36个月，患者呼吸困难完全缓解，能耐受日常生活活动；4例均对自己的声音较为满意，能进行日常的生活交流。结论：显微支撑喉镜CO2激光双侧声带楔形切除术，不需气管切开，术后喉功能恢复快，并发症少。既能解决患者通气的要求，又能保证发声的质量，本方法治疗双侧声带外展麻痹有很好的临床推广使用价值。     

支撑喉镜下杓状软骨切除联合声带外移治疗双侧声带外展麻痹的临床研究

目的探讨支撑喉镜下单侧杓状软骨全切除联合同侧声带外移治疗双侧声带外展麻痹的手术方法和临床意义。方法支撑喉镜下对30例双侧声带外展麻痹伴呼吸困难的患者行CO2激光单侧杓状软骨全切除并用Ejnell法同侧声带外移扩宽声门,手术前、后纤维喉镜检查声门情况,嗓音分析评估发音功能,肺功能检查评估通气情况。结果 30例患者拔管率100%。随访6个月-5年,全部病例无肉芽生长和再狭窄等并发症,均保持语言交流功能。嗓音分析显示基频微扰、振幅微扰手术前、后差异无显著性意义（P均〉0.05）,但手术前、后声门噪声能量、最长声时差异有显著性意义（P均〈0.05）。肺功能显示FEV1、FEV1/FVC手术前、后差异有显著性意义（P均〈0.05）,客观反映了术后气道通气功能改善。结论支撑喉镜下单侧杓状软骨全切除联合同侧声带外移可有效治疗双侧声带外展麻痹,且拔管早,拔管率高,疗效持久,患者的发音功能得到满意的保留,是治疗该类患者的较为理想的方法。     

Laser arytenoidectomy

An endoscopic laser arytenoidectomy was performed on 20 patients for bilateral abductor vocal cord paralysis due to various causes. Ten patients had a previous tracheostomy prior to the laser arytenoidectomy and all were subsequently decannulated. One patient without a previous tracheostomy required an immediate tracheostomy after the completion of the laser arytenoidectomy due to a severe laryngeal edema and was also subsequently decannulated. All of these patients had a satisfactory voice and an adequate laryngeal airway. The advantages of the laser for endoscopic arytenoidectomy are facility of the operation, hemostasis, minimal postoperative edema, and absence of scarring.     

Laser arytenoidectomy for bilateral vocal fold paralysis

Laser arytenoidectomy can be performed via an intralaryngeal approach which preserves airway and voice quality without aspiration. Laser arytenoidectomy is minimally invasive surgery, and a useful surgical procedure for bilateral vocal fold paralysis. CO2 laser arytenoidectomy was performed for 12 cases of bilateral vocal fold paralysis. Recommended methods for this surgical procedure are: 1) Submucous laser arytenoidectomy should be done. 2) To widen the posterior glottis, not only the arytenoid cartilage but also the posterior part of the thyroarytenoid muscle should be removed. 3) Membranous portions of the vocal folds should not be vaporized. 4) The wound should be covered with mucosa with fibrin glue.     

Cricoid cartilage necrosis after arytenoidectomy in a previously irradiated larynx.

Several open and endoscopic surgical techniques are available to provide an adequate airway for patients with bilateral vocal cord paralysis. Transoral laser arytenoidectomy has repeatedly been reported to be a reliable and effective minimally invasive procedure for airway restoration. To our knowledge, there have been no previous reports of serious complications, other than poor vocal results, aspiration, and failed decannulation in individual patients, that have resulted from this intervention. We report a case in which arytenoidectomy led to severe complications and death. Prior irradiation is suspected to be a causative factor. To prevent such an outcome, we believe that operative settings should be chosen that avoid deep thermal injury of the laryngeal framework.     

支撑喉镜下CO2激光杓状软骨切除术治疗双声带外展麻痹

目的 探讨支撑喉镜下ＣＯ２激光显微杓状软骨切除术治疗双声带外展麻痹的手术方法、疗效和适应证。方法１９９４￣１９９８年收治双声带外展麻痹患者８例,其中３例曾在外院经颈外进路手术失败,全部术前行气管切开术。参照并改良Ｏｓｓｏｆｆ窥镜下杓状软骨切除术,汽化杓状软骨前部,包括声带突和部分肌突,一小部分室带及声带后端,保留粘软骨膜并缝合切口,以消灭创面,双侧分次手术。结果 术后无肉芽滋生,无误吸,保留发音功     

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

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。     

支撑喉镜下CO2激光及几丁糖局部涂布治疗喉狭窄

目的：探讨CO2激光辅以局部几丁糖涂布治疗各种类型喉狭窄的手术方法和疗效。方法：1999年1月-2002年1月在全麻支撑喉镜下共行CO2激光辅以局部几丁糖涂布治疗种类喉狭窄患者21例，其中先天性喉2例，不同原因前联合粘连狭窄13例，后联合璞形成3例，喉乳头状瘤多次手术后喉闭锁2例，甲状腺术后双侧声带外展麻痹行杓状软骨切除术后声门狭窄1例。结果：全部患者术后随访6-24个月，18例拔管保留发声功能；3例再狭窄，2例经再次手术后拔管，无误吸，发声较低沉嘶哑；另一例行喉裂开“T”形管扩张。结论：CO2激光手术 几丁糖局部涂布是一种治疗喉狭窄的有效方法，手术安全简便，可避免颈外进路手术，同时保留较好的发声功能。     

红宝石激光同期杓状软骨内侧切除治疗双侧声带麻痹

目的 :探讨支撑喉镜下以红宝石激光同期切除双侧杓状软骨内侧治疗双侧声带麻痹的疗效。方法 :全部患者均行气管切开插管麻醉 ,以红宝石激光同期切除双侧杓状软骨的内侧。结果 :无手术并发症。全部患者随访 3～ 13个月 ,呼吸平稳 ,喉内无瘢痕粘连 ,发音明显好转 ,声门呼吸部较术前扩大≥ 4mm。结论 :以红宝石激光同期行双侧杓状软骨内侧切除治疗双侧声带麻痹是切实可行的。     

Treatment of bilateral vocal cord paralysis following permanent recurrent laryngeal nerve injury

Bilateral vocal cord paralysis is a serious illness requiring emergency intervention to resolve the potentially life-threatening respiratory distress. Several surgical procedures were proposed to help improve the airway and to eliminate the tracheostoma in those patients with permanent paralysis. All the procedures have their own advantages and disadvantages. We conducted a retrospective study of 30 patients affected by bilateral vocal cord paralysis following total thyroidectomy. All the patients underwent total thyroidectomy for benign thyroid pathology. In 26 patients (86.6%), cord paralysis occurred during the perioperative stage; and in the remaining 4 cases (13.3%), it occurred within the following 6 months. We treated all these bilateral recurrent laryngeal nerve paralysis patients with arytenoidectomy alone in 5 patients and arytenoidectomy with concomitant true and false posterior cordectomy in the remaining 25 patients. Twenty-four of the 25 patients who underwent the combined procedures (96%) reported subjective respiratory improvement and were decannulated within 60 days, being able to return to their normal daily activities. This study demonstrates that arytenoidectomy associated with posterior cordectomy is a satisfactory surgical treatment of bilateral vocal cord paralysis because it leads to a considerable and stable enlargement of the breathing space.     

The influence of laser arytenoidectomy on ventilation parameters in patients with bilateral vocal cord paralysis

Bilateral vocal cord paralysis is a symptom that may lead to serious breathing problems. The treatment of patients with vocal cord paralysis presents a challenge to otolaryngologists. Many techniques have been developed in an attempt to improve the patient's airway insufficiency. The aim of the study was to evaluate the efficacy of the laser total unilateral arytenoidectomy with posterior cordectomy in patients with bilateral vocal cord paralysis. Thrity-six patients (33 females, 3 male) aged between 24 and 76 (mean 52) were treated by laser arytenoidectomy. The flow-volume loop and pletysmography were performed in all patients before and after the operation. Additionally, a group of 15 patients with unilateral vocal cord paralysis was introduced and analyzed as a special control. Based on the relative increase of the parameters after the surgery, the most useful of them were selected for the evaluation. Also, the character of the laryngeal obstruction was defined. Changes in the flow-volume loop before and after surgery were compared by planned comparison in univariate analysis ANOVA/MANOVA with an isolated control group. As the parameters AREA(EX), FEF50, FEF75, PEF and MMEF(75/25) increased most effectively, they appeared to be the most useful in the evaluation. FIV1/FEF1, FEF50/FIF50 and FEV1/FEV(0,5) allowed the definition of the obstruction as an extrathoracic dynamically variable quantity. The resistances measured during pletysmography diminished significantly after surgery. The introduction of the special control group with unilateral vocal cord paralysis showed that despite the significant improvement after surgery, the patients who had been operated on still had a laryngeal obstruction worse than that of patients from the control group. The laser arytenoidectomy is shown to be a useful and efficacious procedure for bilateral vocal cord paralysis.     

Bilateral vocal cord palsy: the alternative to tracheostomy.

Bilateral abductor vocal cord paralysis remains a difficult management problem for otolaryngologists. The techniques currently used fall into four main types: arytenoidectomy, cordectomy, cord lateralization and laryngeal re-innervation. These techniques invariably require a tracheostomy either prior to or at the time of the main procedure. A technique for managing patients without performing a tracheostomy which is as effective as the previously mentioned procedures and with no greater morbidity in terms of voice production was initially described by Ejnell, et al (1984). The results in three patients using this technique which involves vocal cord lateralization under endoscopic control confirms its ease and efficacy. All three patients were relieved of their presenting dyspnea and had satisfactory postoperative voice production. This appears to be an effective technique for the treatment of patients with bilateral abductor laryngeal paralysis which obviates the need for tracheostomy and its attendant complications.