Department of Otorhinolaryngology, Jena University Hospital, Lessingstrasse 2, 07740, Jena, Germany.
Eur Arch Otorhinolaryngol. 2014 Feb;271(2):329-35. doi: 10.1007/s00405-013-2655-1. Epub 2013 Aug 22.
Although surgical treatment of patients with chronic vocal cord palsy (VCP) is an integral part of clinical routine of otorhinolaryngologists, there is nearly no population-based data published on incidence and efficiency of this surgery country-wide or nation-wide. 1430 patients with chronic VCP were treated in a department of otorhinolaryngology between 2005 and 2010 in Thuringia, Germany. VCP was unilateral and bilateral in 63 and 18%, respectively. The affected side was not documented in 20%. Iatrogenic lesions of the recurrent nerve (42%) and neoplastic infiltration (27%) were the leading etiologies. 192 patients (13%) received surgical treatment. 31% of patient needed more than one surgery. The rate of surgeries was higher for bilateral VCP (p < 0.0001). Vocal cord augmentation was the most frequent surgery for unilateral VCP and posterior cordectomy for bilateral VCP. The complication rate was high (16%), but not different between unilateral and bilateral VCP (p = 0.108). The risk for tracheostomy was higher in the bilateral VCP group (p < 0.0001). Voice improvement was better after treatment of unilateral VCP (p < 0.0001). Breathing improvement was more frequent after bilateral VCP (p = 0.028). Dysphagia did not improve significantly. The rate of better voice, breathing, and swallowing function was higher in patients treated surgically than without surgery (all p < 0.0001). The rate of patients admitted for treatment of vocal fold palsy was 9.9/100,000 habitants. The surgical rate of VCP was 1.38/100,000 habitants. This population-based analysis shows that surgery for VCP is performed with higher incidence than expected effectively, but with relevant risks in daily routine of otorhinolaryngologists.
尽管慢性声带麻痹（VCP）患者的手术治疗是耳鼻喉科医生临床常规的重要组成部分，但在全国范围内，几乎没有关于这种手术发病率和疗效的基于人群的数据。2005 年至 2010 年期间，德国图林根州的一个耳鼻喉科部门治疗了 1430 例慢性 VCP 患者。VCP 单侧和双侧分别为 63%和 18%。20%的患者未记录受影响的一侧。医源性喉返神经损伤（42%）和肿瘤浸润（27%）是主要病因。192 例患者（13%）接受了手术治疗。31%的患者需要进行多次手术。双侧 VCP 的手术率较高（p<0.0001）。单侧 VCP 最常见的手术是声带增强术，双侧 VCP 最常见的手术是后声带切除术。并发症发生率较高（16%），但单侧和双侧 VCP 之间无差异（p=0.108）。双侧 VCP 组气管切开术的风险较高（p<0.0001）。单侧 VCP 治疗后声音改善更好（p<0.0001）。双侧 VCP 后呼吸改善更常见（p=0.028）。吞咽困难无明显改善。手术治疗的患者中，声音、呼吸和吞咽功能改善的比例高于未手术治疗的患者（均 p<0.0001）。因声带麻痹接受治疗的患者比例为 9.9/10 万居民。VCP 的手术率为 1.38/10 万居民。这项基于人群的分析表明，VCP 的手术治疗在耳鼻喉科医生的日常工作中以较高的发病率有效进行，但存在相关风险。
