Rovó László, Venczel Kincsõ, Torkos Attila, Majoros Valéria, Sztanó Balázs, Jóri József
Department of Otorhinolaryngology and Head & Neck Surgery, Medical Faculty of the Szeged University, Szeged, Hungary.
Laryngoscope. 2008 Sep;118(9):1550-5. doi: 10.1097/MLG.0b013e31817c0b32.
OBJECTIVES/HYPOTHESIS: A posterior glottic stenosis (PGS) may limit the abduction of the arytenoid cartilages. One option for the treatment of dyspnea in lower grade stenoses is endoscopic laterofixation of the vocal cords after scar excision. In our prospective study, we assess a refined method for effective endoscopic mobilization and lateropexy of the arytenoid cartilages.
Thirty-two consecutive patients with PGS underwent surgery. Endoscopically, the scar between the arytenoid cartilages was transected with a CO2 laser. The scars that had spread into the cricoarytenoid joint were transected with a right-angled endolaryngeal scythe designed for this purpose. The lateropexy of the adequately mobilized arytenoid cartilages was performed with a reinforced Lichtenberger's needle carrier instrument, with consideration of the real abduction of the cricoarytenoid joint.
Twenty-eight patients achieved an excellent breathing ability, only effort dyspnea remained in three cases. One patient could not be decannulated due to aspiration. The early postoperative improvement in the airway function test results showed no relationship with the grade of stenoses. However, in cases of higher grade stenoses with bilateral joint damage, the later postoperative airway function results had decreased slightly. In 25 cases, phonation significantly improved after the removal of the fixing sutures.
After proper mobilization, endoscopic arytenoid lateropexy can be considered as a minimally invasive function-preserving procedure even for severe PGS. This treatment option provides stable improvements in breathing ability and good voice quality without the need for tracheostomy.
目的/假设：后声门狭窄（PGS）可能会限制杓状软骨的外展。对于轻度狭窄引起的呼吸困难，一种治疗选择是在切除瘢痕后进行声带内镜外侧固定术。在我们的前瞻性研究中，我们评估了一种改进的方法，用于有效地内镜下活动杓状软骨并进行外侧固定。
连续32例PGS患者接受了手术。在内镜下，用二氧化碳激光切断杓状软骨之间的瘢痕。对于蔓延至环杓关节的瘢痕，使用为此目的设计的直角喉内镰刀进行切断。使用改良的利希滕贝格持针器对充分活动的杓状软骨进行外侧固定，同时考虑环杓关节的实际外展情况。
28例患者呼吸能力极佳，仅3例仍有劳力性呼吸困难。1例患者因误吸无法拔管。术后早期气道功能测试结果的改善与狭窄程度无关。然而，在双侧关节受损的重度狭窄病例中，术后后期气道功能结果略有下降。25例患者在拆除固定缝线后发声明显改善。
经过适当的活动后，即使对于严重的PGS，内镜下杓状软骨外侧固定术也可被视为一种微创的保留功能的手术。这种治疗方法能稳定改善呼吸能力并提供良好的嗓音质量，而无需气管切开术。
