膈神经和舌下神经选择性再神经支配治疗双侧声带麻痹。
Selective reinnervation using phrenic nerve and hypoglossal nerve for bilateral vocal fold paralysis.
机构信息
Department of Otolaryngology-Head and Neck Surgery, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China.
出版信息
Laryngoscope. 2019 Nov;129(11):2669-2673. doi: 10.1002/lary.27768. Epub 2019 Feb 12.
OBJECTIVE
To evaluate the extent of airway improvement and voice quality in patients with bilateral vocal fold paralysis (BVFP) who underwent selective laryngeal reinnervation surgery.
METHODS
Seven patients with BVFP caused by thyroid surgeries were enrolled. They underwent selective laryngeal reinnervation surgery. Videostroboscopy data, voice perceptual data (grade [G]), acoustic data, laryngeal electromyography data, and pulmonary function test data were obtained preoperatively and postoperatively.
RESULTS
Videostroboscopic videos showed that six patients could achieve moderate-to-maximal abduction in the bilateral vocal folds during inspiration, whereas all patients achieved adduction in the bilateral vocal folds during phonation at 4 to 7 months postoperatively. G score was decreased significantly versus preoperative values (P < 0.05), and vocal functional parameters were improved significantly at 12 months postoperatively (P < 0.05). The aerodynamic parameter of maximum phonation time was significantly longer than the preoperative value (P < 0.05). Most parameters in pulmonary function test recovered to normal reference levels as early as 3 months postoperatively, whereas maximal inspiratory pressure (PImax) values were still slightly lower than normal levels 12 months after surgery. All of these parameters improved significantly versus preoperative values. Electromyographic data at 12 months postoperatively showed full interference potentials in bilateral posterior cricoarytenoid muscles during inspiration and full interference potentials in bilateral thyroarytenoid muscles during phonation in all patients. Moderate electric potentials were seen in left interarytenoid muscle in one failed patient.
CONCLUSION
This new selective laryngeal reinnervation procedure can achieve physiological movements of the bilateral vocal folds in selected patients with BVFP.
LEVEL OF EVIDENCE
- Laryngoscope, 129:2669-2673, 2019.
目的
评估双侧声带麻痹（BVFP）患者行选择性喉返神经再支配手术后气道改善和嗓音质量的程度。
方法
纳入 7 例因甲状腺手术引起的 BVFP 患者，行选择性喉返神经再支配手术。分别于术前和术后获取频闪喉镜检查数据、嗓音感知数据（等级[G]）、声学数据、喉肌电图数据和肺功能检查数据。
结果
频闪喉镜视频显示，6 例患者在吸气时双侧声带可达到中度至最大外展，而所有患者在术后 4 至 7 个月发声时双侧声带均可内收。G 评分与术前相比显著降低（P < 0.05），并且术后 12 个月嗓音功能参数显著改善（P < 0.05）。最大发声时间的空气动力学参数明显长于术前值（P < 0.05）。大多数肺功能检查参数在术后 3 个月即可恢复到正常参考水平，而最大吸气压力（PImax）值在术后 12 个月仍略低于正常水平，所有这些参数与术前相比均显著改善。术后 12 个月的肌电图数据显示，所有患者吸气时双侧环杓后肌均出现完全干扰电位，发声时双侧甲杓肌均出现完全干扰电位；1 例失败患者左侧杓间肌出现中度电活动。
结论
这项新的选择性喉返神经再支配术可使选定的双侧声带麻痹患者的双侧声带实现生理运动。
证据水平
4。《喉镜》，129：2669-2673，2019。
Zotero 插件