Abraham M T, Gonen M, Kraus D H
Department of Otolaryngology, New York University School of Medicine, New York, NY, U.S.A.
Laryngoscope. 2001 Aug;111(8):1322-9. doi: 10.1097/00005537-200108000-00003.
OBJECTIVES/HYPOTHESIS: Unilateral vocal fold paralysis resulting in glottal incompetence can cause significant morbidity attributable to impaired speech, swallowing, and ability to protect the airway. Type I thyroplasty in combination with arytenoid adduction is a proven technique for medialization of the paralyzed vocal fold but must be evaluated in light of potential complications following laryngeal framework surgery.
The charts of 237 patients who underwent unilateral vocal fold medialization surgery between July 1, 1991, and August 30, 1999, at a tertiary care cancer referral center were retrospectively reviewed.
There were 98 cases of type I thyroplasty alone and 96 cases of type I thyroplasty with arytenoid adduction. The two groups had similar patient characteristics. Mean time of surgery (45 vs. 73 min, P <.0001) and length of hospital stay (1.1 vs. 1.8 d, P <.0001) were increased when arytenoid adduction was performed. Overall improvement of symptoms was similar in both groups (93%-94%), but posterior glottic closure appeared subjectively improved when arytenoid adduction was used (P =.0054). Overall complication rates were slightly higher in the arytenoid adduction group (14% vs. 19%), primarily because of transient vocal fold edema and wound complications (9 vs. 19 cases), but the increase was not statistically significant (P =.1401). Complications warranting medical or surgical intervention occurred in 8% of cases. Two patients who underwent type I thyroplasty with arytenoid adduction required tracheotomy as a consequence of postoperative complications. The three patients who had extrusion of the implant underwent type I thyroplasty alone.
Using the appropriate technique, the potential benefits of improved glottic function following type I thyroplasty with arytenoid adduction outweigh the small risk of significant complications observed.
目的/假设：单侧声带麻痹导致声门功能不全，可因言语、吞咽及气道保护能力受损而引起严重的发病率。I型甲状成形术联合杓状软骨内收术是一种已被证实的使麻痹声带内移的技术，但必须根据喉框架手术后的潜在并发症进行评估。
回顾性分析了1991年7月1日至1999年8月30日在一家三级癌症转诊中心接受单侧声带内移手术的237例患者的病历。
单纯I型甲状成形术98例，I型甲状成形术联合杓状软骨内收术96例。两组患者特征相似。进行杓状软骨内收术时，平均手术时间（45分钟对73分钟，P<.0001）和住院时间（1.1天对1.8天，P<.0001）增加。两组症状总体改善情况相似（93%-94%），但使用杓状软骨内收术时，声门后联合关闭主观上似乎有所改善（P=.0054）。杓状软骨内收术组总体并发症发生率略高（14%对19%），主要是由于短暂性声带水肿和伤口并发症（9例对19例），但增加无统计学意义（P=.1401）。需要药物或手术干预的并发症发生率为8%。两名接受I型甲状成形术联合杓状软骨内收术的患者因术后并发症需要气管切开术。三名植入物脱出的患者仅接受了I型甲状成形术。
采用适当技术，I型甲状成形术联合杓状软骨内收术后声门功能改善的潜在益处超过了观察到的发生严重并发症的小风险。
