Misiolek Maciej, Ziora Dariusz, Namyslowski Grzegorz, Misiolek Hanna, Kucia Jaroslaw, Scierski Wojciech, Kozielski Jerzy, Warmuzinski Krzysztof
ENT Department, Silesian Medical University, Sklodowskiej-Curie 10, 41-800, Zabrze, Poland.
Eur Arch Otorhinolaryngol. 2007 Aug;264(8):895-900. doi: 10.1007/s00405-007-0288-y. Epub 2007 Apr 6.
The problem of ventilation efficiency after total laser arytenoidectomy with posterior cordectomy due to bilateral vocal cord paralysis is discussed. There are a number of views on the usefulness and efficacy of different surgical procedures aimed at widening the glottis, but the studies concerning the long-term functional results are still lacking. The objective of the study is to evaluate the durability of ventilation results in patients after laser arytenoidectomy with posterior cordectomy based on the comparison between the early postoperative results and those assessed after a period of 5 years. Thirty patients (24 females, 6 males) aged between 30 and 80 (mean 58.5) with bilateral vocal cord paralysis after thyroid surgery, who underwent laser arytenoidectomy with posterior cordectomy, were analyzed. Ventilation tests were performed immediately after the operation and 5 years later with Body-Master Laab (Jaeger). The actual and predicted values of FVC, FEF(25), FEF(50), FEF(75), PEF, MMEF(75/25), AREA(Ex), sR(T0T), R(T0T) were compared and analyzed. Also, the values of the inspiratory parameters FIV(1), FIF(50), PIF and the coefficients FEF(50)/FIF(50) and FIV(1)/FEV(1) were assessed. Moreover, subjective evaluation was performed based on a questionnaire. The statistical analysis reveals a significant decrease in FIV(1), FIF(50), PIF and FIV(1)/FEV(1). FEF(50)/FIF(50) and sR(T0T) (actual and predicted values) increased significantly after 5 years from the operation. However, the patients did not complain nor was this tendency reflected in their answers to the questionnaire. The probable reasons for such ventilation results are discussed. The role of phoniatric rehabilitation and the time elapsed is emphasized. In general, it can be concluded that laser arytenoidectomy with posterior cordectomy is a durable and effective procedure, although the objective assessment does not fully match the patient's subjective impression.
讨论了因双侧声带麻痹行全激光杓状软骨切除术加后索切除术的通气效率问题。对于旨在扩大声门的不同手术方法的实用性和有效性存在多种观点，但关于长期功能结果的研究仍然缺乏。本研究的目的是通过比较术后早期结果与5年后评估的结果，评估激光杓状软骨切除术加后索切除术患者通气结果的持久性。分析了30例年龄在30至80岁（平均58.5岁）之间，因甲状腺手术后出现双侧声带麻痹并接受激光杓状软骨切除术加后索切除术的患者（24例女性，6例男性）。术后立即和5年后使用Body-Master Laab（耶格公司）进行通气测试。比较并分析了用力肺活量（FVC）、25% 用力呼气流量（FEF(25)）、50% 用力呼气流量（FEF(50)）、75% 用力呼气流量（FEF(75)）、呼气峰值流量（PEF）、最大呼气中期流量（MMEF(75/25)）、呼出面积（AREA(Ex)）、静态总阻力（sR(T0T)）、总阻力（R(T0T)）的实际值和预测值。此外，还评估了吸气参数吸气流速（FIV(1)）、50% 吸气流量（FIF(50)）、吸气峰压（PIF）以及FEF(50)/FIF(50)和FIV(1)/第一秒用力呼气容积（FEV(1)）的系数。此外，基于问卷进行了主观评估。统计分析显示FIV(1)、FIF(50)、PIF和FIV(1)/FEV(1)显著下降。术后5年，FEF(50)/FIF(50)和sR(T0T)（实际值和预测值）显著增加。然而，患者并未抱怨，问卷调查答案中也未体现出这种趋势。讨论了出现这种通气结果的可能原因。强调了发声康复和时间流逝的作用。总体而言，可以得出结论，激光杓状软骨切除术加后索切除术是一种持久且有效的手术方法，尽管客观评估与患者的主观印象并不完全相符。
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