【作者】 徐蕊；

【导师】 娄卫华；

【作者基本信息】 郑州大学 ， 耳鼻咽喉头颈外科学（专业学位）， 2020， 硕士

【摘要】 背景:双侧声带麻痹(bilateral vocal cord paralysis,BVCP)是一种会影响呼吸、嗓音和吞咽功能,从而严重影响生活质量甚至威胁生命的疾病。它是指喉返神经功能障碍导致的声带运动障碍,需排除环杓关节脱位,肿瘤侵犯声带肌等原因导致的声带固定。双侧声带麻痹的病因众多,包括占位性病变、医源性损伤、外伤、炎症、特发性等,最常见的原因是甲状腺切除术后,尤其是二次甲状腺手术后[1-3],第二常见的病因是肿瘤[4]。随着喉返神经监测仪器在临床上的逐渐普及,声带麻痹患者数量有所降低。双侧声带麻痹患者可能会出现呼吸困难、喉喘鸣、音调减低、声音嘶哑、进食呛咳甚至窒息等症状[5,6]。治疗双侧声带麻痹的手术方式主要有杓状软骨切除术,声带外移固定术[7],声带切除术[8]。手术疗效临床报道不一,目前临床上就采用何种手术方式尚未达成统一。目的:探讨喉裂开单侧杓状软骨切除术与内镜下低温等离子单侧杓状软骨切除术治疗双声带麻痹的临床疗效。方法:对2014年1月至2019年5月在我院行手术治疗的双侧声带麻痹患者68例进行回顾性分析,其中31例行喉裂开单侧杓状软骨切除术,37例行经支撑喉镜下低温等离子单侧杓状软骨切除术,术后随访6～62月,记录手术时间,术中出血量,术后拔管率,根据嗓音障碍指数问卷自我评估量表记录成功拔管的患者手术6月后的VHI值,根据误吸程度分级记录患者术后误吸情况,对比两种手术方式的手术情况,呼吸改善情况,声音质量及吞咽功能,评估两种手术的疗效。结果:1、喉裂开组比内镜组的手术时间长,术中出血量多,差异有统计学意义(P<0.05)。2、喉裂开组的拔管率为87.1%,内镜组的拔管率为91.9%,两组拔管率差异无统计学意义(P>0.05)。3、喉裂开组术后VHI值大于术前,差异有统计学意义(P<0.05)。内镜组术后VHI值大于术前,差异有统计学意义(P<0.05)。喉裂开组术后VHI值大于内镜组术后VHI值,差异有统计学意义(P<0.05)。4、喉裂开组术后第1天,术后2周及术后2月的误吸程度均与内镜组相当,差异无统计学意义(P>0.05)。结论:支撑喉镜下低温等离子单侧杓状软骨切除术拔管率高,对喉的功能损伤小,操作简单,手术时间短,出血少,有很大临床应用价值。喉裂开单侧杓状软骨切除术同样具有很高的拔管率,但创伤较内镜手术大,术后嗓音下降更明显,对于只有基础手术设备的医院可以采纳,对于支撑喉镜下暴露困难的患者可以选择此手术方式。更多还原

【Abstract】 BackgroundBilateral vocal cord paralysis(BVCP)is a disease that can affect breathing,sound,and swallowing,which can seriously affect quality of life and even threaten life.It refers to vocal cord dyskinesia caused by dysfunction of recurrent laryngeal nerve,and it is necessary to exclude vocal cord fixation caused by dislocation of the cricoarytenoid joint and tumor invasion of vocal cord muscles.There are many causes of BVCP,including space-occupying lesions,iatrogenic injuries,trauma,inflammation,idiopathic,etc[1-3].The most common cause is after thyroidectomy,especially after Secondary surgery.The second most common cause is tumor[4].As the use of recurrent laryngeal nerve monitoring instruments has become more widespread in clinical practice,the number of patients with VCP has decreased.Patients with BVCP may experience some symptoms such as dyspnea,throat wheezing,decreased tone,hoarseness,aspiration,and even choking[5,6].The main surgical methods of BVCP include arytenoidectomy,laterofixation[7],and cordotomy[8].In terms of the clinical efficacy of surgery,the reports were inconsistent,and there is currently no consensus on which is the most suitable surgical approach clinically.ObjectiveTo explore the clinical efficacy in the treatment of BVCP by comparing unilateral arytenoidectomy through larngofissure with endoscopic coblation unilateral arytenoidectomy.MethodsA retrospective analysis of 68 patients with BVCP who underwent surgical treatment in our hospital from January 2014 to May 2019.Of these,31 patients underwent unilateral arytenoidectomy by larngofissure,and 37 patients underwent low-temperature plasma unilateral arytenoidectomy under laryngoscope.The follow-up period was 6 to 62 months.The operation time,intraoperative blood loss and post-extubation rate were recorded.According to the Voice Handicap Index Questionnaire Self-Assessment Scale,the VHI values of patients who were successfully extubated and had the operation after 6 months were recorded.According to the degree of aspiration,the condition of postoperative aspiration was recorded.To compare the surgical conditions,the improvement conditions of breath,sound quality and swallowing function of the two surgical methods to evaluate the surgical efficacy.Results1.The larngofissure group had a longer operation time than the endoscopic group,and there was more intraoperative blood loss.The discrepancy was statistically significant(P<0.05).2.The extubation rate of the larngofissure group was 87.1%.The extubation rate of the endoscopic group was 91.9%.The discrepancy of the extubation rate was not statistically significant(P>0.05).3.The postoperative larngofissure group had a VHI value greater than that before surgery,and the discrepancy was statistically significant(P<0.05).The postoperative endoscopic group had a higher VHI value than that before surgery,and the discrepancy was significant(P<0.05).The VHI value after surgery of the laryngofissure group was greater than that of the endoscopic group,and the discrepancy was statistically significant(P<0.05).4.According to the degree of aspiration at 1 day,2 weeks and 2 months after surgery,the degree of aspiration in the larngofissure group was similar to the endoscope group,and the discrepancy was not statistically significant(P>0.05).ConclusionEndoscopic coblation assisted unilateral arytenoidectomy has a high extubation rate,minor damage to the laryngeal function,simple operation,short operation time,and less bleeding,which is worthy to apply in clinics.Unilateral arytenoidectomy by larngofissure also has a high extubation rate,but the trauma was more serious and the voice decreased more obviously after operation,which can be adopted by hospitals who only have basic surgical equipments,and can be selected for patients who have difficulty in supporting exposure under laryngoscope.更多还原