University of Kansas School of Medicine, Kansas City, Kansas, USA.
Otolaryngol Head Neck Surg. 2014 May;150(5):827-33. doi: 10.1177/0194599814522413. Epub 2014 Feb 10.
To determine the incidence of vocal cord (VC) paralysis and dysphagia after aortic arch reconstruction, including the Norwood procedure.
Tertiary children's hospital.
Retrospective cohort.
Database/chart review of neonates requiring Norwood or arch surgery between January 2005 and December 2012. Demographics, postoperative VC function, dysphagia, need for gastrostomy tube and/or tracheotomy, and long-term follow-up were reviewed.
One hundred fifty-one consecutive subjects (96 Norwood, 55 aortic arch) were reviewed. Median age at repair was 9 days (interquartile range [IQR], 7-13) for Norwood and 24 days (IQR, 12-49) for arch reconstruction (P < .001). Documentation of VC motion abnormality was found in 60 of 104 (57.6%) subjects and unavailable in 47 (16 without documentation and 31 who died prior to extubation). There were no significant differences in proportions of documented VC motion (P = .337), dysphagia (P = .987), and VC paralysis (P = .706) between the arch and Norwood groups. Dysphagia was found in 73.5% of Norwood and 69.2% of arch subjects who had documented VC paralysis. Even without unilateral VC paralysis (UVCP), dysphagia was present (56% Norwood, 61% arch). Overall, 120 of 151 (79.5%) required feeding evaluation and a modified feeding regimen. Gastrostomy was required in 31% of Norwood and 23.6% of arch reconstruction overall. To date, mortality in this series is 55 of 151 (36.4%) patients. Of those with VC paralysis, only 23 (22%) had any otolaryngology follow-up after discharge from surgery. More than 75% with VC paralysis with follow-up after hospital discharge had persistent VC paralysis 11.5 months after diagnosis.
There is high incidence of UVCP and dysphagia after Norwood and arch reconstruction. Dysphagia was highly prevalent in both groups even without UVCP. Preoperative discussion on vocal cord function and dysphagia should be considered.
确定主动脉弓重建术后（包括 Norwood 手术）声带（VC）麻痹和吞咽困难的发生率。
三级儿童医院。
回顾性队列研究。
对 2005 年 1 月至 2012 年 12 月期间需要 Norwood 或弓手术的新生儿进行数据库/图表回顾。回顾了人口统计学资料、术后 VC 功能、吞咽困难、胃造口管和/或气管切开术的需求以及长期随访情况。
共回顾了 151 例连续病例（96 例 Norwood，55 例主动脉弓）。Norwood 修复的中位年龄为 9 天（四分位距 [IQR]，7-13），主动脉弓重建的中位年龄为 24 天（IQR，12-49）（P<.001）。在 104 例中有 60 例（57.6%）有 VC 运动异常的记录，47 例（16 例无记录，31 例在拔管前死亡）无法获得记录。在有 VC 运动记录的病例中，两组之间的 VC 运动（P=.337）、吞咽困难（P=.987）和 VC 麻痹（P=.706）的比例无显著差异。Norwood 组和弓组有 VC 麻痹的病例分别有 73.5%和 69.2%出现吞咽困难。即使没有单侧 VC 麻痹（UVCP），也存在吞咽困难（Norwood 组 56%，弓组 61%）。总体而言，151 例中有 120 例（79.5%）需要进行喂养评估和改良喂养方案。Norwood 组和弓组总体上分别有 31%和 23.6%需要胃造口术。到目前为止，本系列中死亡率为 151 例中的 55 例（36.4%）。在有 VC 麻痹的病例中，只有 23 例（22%）在手术后出院后有任何耳鼻喉科随访。在出院后有随访的 VC 麻痹病例中，超过 75%的病例在诊断后 11.5 个月仍存在持续的 VC 麻痹。
Norwood 和弓重建术后有很高的 UVCP 和吞咽困难发生率。即使没有 UVCP，两组的吞咽困难发生率也很高。术前应讨论 VC 功能和吞咽困难的问题。
