Kara H Volkan, Karaaltin Aysegul Batioglu, Ersen Ezel, Alaskarov Elvin, Kilic Burcu, Turna Akif
Department of Thoracic Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
Department of Ear Nose Throat, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
Wideochir Inne Tech Maloinwazyjne. 2018 Sep;13(3):388-393. doi: 10.5114/wiitm.2018.75886. Epub 2018 May 22.
Video-assisted mediastinal lymphadenectomy (VAMLA) is a valuable tool for invasive staging of the mediastinum. Unilateral vocal cord paralysis (UVCP) may occur in patients following VAMLA and may result in secretion retention within the lungs, atelectasis and associated infectious situations such as pneumonia. Minimally invasive injection laryngoplasty (ILP) is the treatment of choice in UVCP.
To evaluate the efficacy and success of acute minimally invasive injection laryngoplasty for patients with UVCP following VAMLA.
Patients with the symptom of dysphonia following VAMLA were reviewed. All of the patients had UVCP according to the video laryngoscopy examination and had symptoms of aspiration and ineffective coughing. The Voice Handicap Index (VHI) questionnaire and maximum phonation time (MPT) were measured. Minimally invasive ILP was performed under general anesthesia with 1 cm of hyaluronic acid.
There were 525 consecutive non-small cell lung cancer (NSCLC) patients who underwent VAMLA. Five (0.95%) of the patients had UVCP and were suffering from aspiration during oral intake and ineffective coughing reflex. Maximum phonation time (MFT) was measured before and after ILP, and the results were 7.1 ±1.6 and 11.1 ±2.3 s, respectively (p < 001). The Voice Handicap Index-10 (VHI-10) score was 30.4 ±4.7 and 13.4 ±3.5 (p < 0.01), respectively. Patients underwent surgical lung resection. There was no morbidity or mortality.
Unilateral vocal cord paralysis may occur as a complication of VAMLA. ILP may be an active tool for treating UVCP before anatomical lung resection to avoid potential morbidities. Successful management of this complication with multidisciplinary team work may encourage the use of VAMLA more frequently.
电视辅助纵隔淋巴结清扫术（VAMLA）是纵隔侵入性分期的一项重要手段。接受VAMLA的患者可能会出现单侧声带麻痹（UVCP），进而导致肺内分泌物潴留、肺不张以及诸如肺炎等相关感染情况。微创注射喉成形术（ILP）是治疗UVCP的首选方法。
评估急性微创注射喉成形术对VAMLA术后出现UVCP患者的疗效与成功率。
对VAMLA术后出现声音嘶哑症状的患者进行回顾性分析。所有患者经电子喉镜检查均确诊为UVCP，且存在误吸和咳嗽无力症状。采用嗓音障碍指数（VHI）问卷和最长发声时间（MPT）进行评估。在全身麻醉下用1厘米透明质酸行微创ILP。
连续525例非小细胞肺癌（NSCLC）患者接受了VAMLA。其中5例（0.95%）出现UVCP，存在经口进食时误吸及咳嗽反射无力的情况。分别在ILP前后测量最长发声时间（MFT），结果分别为7.1±1.6秒和11.1±2.3秒（p<0.01）。嗓音障碍指数-10（VHI-10）评分分别为30.4±4.7和13.4±3.5（p<0.01）。患者均接受了肺手术切除。无并发症或死亡发生。
单侧声带麻痹可能作为VAMLA的并发症出现。ILP可能是在解剖性肺切除术前治疗UVCP以避免潜在并发症的有效手段。多学科团队协作成功处理这一并发症可能会促使更频繁地使用VAMLA。
