Riffat F, Palme C E, Veivers D
Department of Otolaryngology, Head and Neck Surgery, Royal North Shore Hospital and Westmead Hospital, Sydney, New South Wales, Australia.
J Laryngol Otol. 2012 May;126(5):503-5. doi: 10.1017/S002221511100301X. Epub 2011 Nov 1.
Treatment of glottic stenosis is a considerable challenge to the otolaryngologist. Glottic airway patency can be compromised by bilateral vocal fold palsy, anterior webbing or a posterior segment scar, which may be significant enough to impair arytenoid movement.
A retrospective analysis of a prospective database of patients (n = 34) treated by a specialist airway surgeon. All patients underwent endoscopic treatment with a CO(2) laser in an attempt to improve airway calibre and, in 12 patients, to decannulate tracheostomy tubes.
Twenty-one patients had bilateral vocal fold palsy and 13 had predominantly posterior glottic stenosis. A variety of pathology-directed treatment approaches were used to achieve good functional results. Four patients required a second endoscopic procedure. The overall revision rate was 5 per cent for bilateral fold palsy and 23 per cent for posterior glottic stenosis (p < 0.05). All patients had an adequate functional airway calibre, and all 12 tracheotomised patients were decannulated.
Pathology-directed endoscopic laser surgery is safe and effective treatment for glottic stenosis. Rather prescriptive use of unilateral or bilateral cordotomy or combined cordo-arytenoidectomy, clinicians must perform the procedure that will treat the lesion most adequately. Our success rate compared favourably with the best reported results.
声门狭窄的治疗对耳鼻喉科医生来说是一项巨大挑战。双侧声带麻痹、前部蹼状瘢痕或后部节段性瘢痕可损害声门气道通畅性，严重时可能会影响杓状软骨运动。
对一位气道外科专家治疗的患者前瞻性数据库（n = 34）进行回顾性分析。所有患者均接受二氧化碳激光内镜治疗，以改善气道口径，其中12例患者还进行了气管造口管拔管。
21例患者为双侧声带麻痹，13例主要为声门后狭窄。采用了多种针对病理的治疗方法以取得良好的功能效果。4例患者需要进行第二次内镜手术。双侧声带麻痹的总体修正率为5%，声门后狭窄为23%（p < 0.05）。所有患者的气道口径功能均足够，所有12例行气管切开术的患者均成功拔管。
针对病理的内镜激光手术是治疗声门狭窄的安全有效方法。临床医生不应刻板地使用单侧或双侧声带切开术或联合声带杓状软骨切除术，而必须采取最能充分治疗病变的手术方式。我们的成功率与已报道的最佳结果相比具有优势。
