Haukeland University Hospital, Department of Paediatrics, N-5021 Bergen, Norway.
Pediatrics. 2010 Dec;126(6):e1569-77. doi: 10.1542/peds.2010-1129. Epub 2010 Nov 22.
The goal was to study the incidence and long-term consequences of left vocal cord paralysis (LVCP) after neonatal surgical treatment of patent ductus arteriosus (PDA) in a population-based cohort of adults who were born at gestational ages of ≤28 weeks or with birth weights of ≤1000 g in western Norway.
Subjects with a history of neonatal PDA surgery were examined with transnasal flexible laryngoscopy, and those with LVCP were examined with continuous laryngoscopy during maximal treadmill exercise (continuous laryngoscopy exercise testing). All subjects underwent lung function testing, ergospirometry, and pulmonary high-resolution computed tomography. Symptoms were recorded with a questionnaire.
Forty-four (86%) of 51 eligible preterm infants participated in the study, 13 (26%) had a history of PDA surgery and 7 (54%) had LVCP, with the laryngeal appearances varying slightly. As a group, subjects with LVCP had significant airway obstruction, no decreases in aerobic capacity, and no obvious evidence of longstanding aspiration on high-resolution computed tomography scans. The continuous laryngoscopy exercise tests revealed increasing respiratory symptoms in parallel with increasing anteromedial collapse of the left aryepiglottic folds as the exercise load increased. Hoarseness and voice-related symptoms were the most typical complaints. Symptoms were attributed erroneously to other diseases for at least 2 subjects.
LVCP is not uncommon in young adults exposed to PDA surgery as preterm infants. The condition may be overlooked easily, and symptoms may be confused with those of other diseases. Laryngoscopy should be offered on the basis of liberal indications after PDA ligation.
在挪威西部一个基于人群的队列中，研究≤28 孕周出生或出生体重≤1000g 的新生儿接受动脉导管未闭（PDA）手术治疗后左声带麻痹（LVCP）的发生率和长期后果。
对有新生儿 PDA 手术史的患者进行经鼻软式喉镜检查，对有 LVCP 的患者进行最大踏车运动时的连续喉镜检查（连续喉镜运动试验）。所有患者均进行肺功能检查、运动肺量测定和肺部高分辨率计算机断层扫描。采用问卷调查记录症状。
51 名符合条件的早产儿中有 44 名（86%）参加了研究，13 名（26%）有 PDA 手术史，7 名（54%）有 LVCP，声带外观略有不同。作为一个整体，LVCP 患者存在明显的气道阻塞，有氧运动能力没有下降，高分辨率计算机断层扫描也没有明显的长期吸入证据。连续喉镜运动试验显示，随着运动负荷的增加，左杓会厌皱襞的前内侧塌陷程度逐渐增加，呼吸症状也逐渐加重。声音嘶哑和与声音相关的症状是最典型的主诉。至少有 2 名患者的症状被错误地归因于其他疾病。
在作为早产儿接受 PDA 手术的年轻成年人中，LVCP 并不少见。这种情况可能很容易被忽视，症状可能与其他疾病的症状相混淆。在 PDA 结扎后，应根据广泛的适应证提供喉镜检查。
