改良杓状软骨内收术治疗单侧声带麻痹。
Modified Arytenoid Adduction Operation for the Treatment of Unilateral Vocal Fold Paralysis.
机构信息
Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China,
Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, China,
出版信息
ORL J Otorhinolaryngol Relat Spec. 2022;84(3):205-210. doi: 10.1159/000517561. Epub 2021 Aug 12.
INTRODUCTION
Unilateral vocal fold paralysis (UVFP) was a relative common glottic insufficiency disease; however, a completely satisfactory treatment of UVFP was elusive. This study was aimed to evaluate the surgical efficacy of modified arytenoid adduction with fenestration of the thyroid cartilage in the management of patients with UVFP, including voice and aspiration outcomes, and to summarize the postoperative complications.
METHODS
A retrospective analysis was performed on a total of 21 patients who underwent modified arytenoid adduction operation with fenestration of the thyroid cartilage for UVFP from July 2012 to June 2017. The scores of Grade, Roughness, Breathiness, Asthenia, Strain scale (GRBAS), voice self-satisfaction, dynamic laryngoscopy and the voice acoustic data (fundamental frequency [F0], fundamental frequency perturbation [jitter], loudness, amplitude perturbation [shimmer], and maximal phonatory time [MPT], etc.) were statistically analyzed preoperatively and 3-6 months postoperatively. The occurrence of postoperative complications was also summarized.
RESULTS
The voice subjective perception of 21 patients was significantly improved after operation. The rate of voice self-satisfaction was 90.5%. The mean values of voice acoustics parameters were significantly improved. The MPT was significantly longer (p < 0.001), and the ratings of postoperative aspiration were significantly decreased compared with the preoperation. Among the 21 patients, 15 cases had sense of laryngeal obstruction, 8 cases had of 1-2° laryngemphraxis (recovered after 10-15 days). There were 2 cases of laryngeal stridor, 1 case of incision infection, 1 case of pharyngeal fistula, and 1 case of falsetto (corrected by voice training). No patient had laryngeal hematoma, neck hematoma, or laryngospasm.
CONCLUSION
The modified arytenoid adduction operation with fenestration of the thyroid cartilage can significantly improve the vocal function of patients with UVFP and effectively reduce the aspiration, with fewer postoperative complications, less trauma, and more convenient advantages.
简介
单侧声带麻痹（UVFP）是一种相对常见的声门不全疾病；然而，UVFP 的完全满意的治疗方法难以捉摸。本研究旨在评估改良杓状软骨内收加甲状软骨开窗术治疗单侧声带麻痹的手术疗效，包括嗓音和吸入结果，并总结术后并发症。
方法
回顾性分析 2012 年 7 月至 2017 年 6 月期间因单侧声带麻痹行改良杓状软骨内收加甲状软骨开窗术的 21 例患者。对术前和术后 3-6 个月的嗓音 GRBAS（等级、粗糙、气息、乏力、紧张）评分、嗓音自我满意度、动态喉镜和嗓音声学数据（基频[F0]、基频微扰[jitter]、响度、振幅微扰[shimmer]和最大发音时间[MPT]等）进行统计学分析。还总结了术后并发症的发生情况。
结果
21 例患者术后嗓音主观感知明显改善，嗓音自我满意度为 90.5%。嗓音声学参数的平均值明显改善，MPT 明显延长（p<0.001），术后吸入评分明显降低。21 例患者中，15 例有喉阻塞感，8 例有 1-2°喉肿胀（10-15 天后恢复）。2 例出现喉喘鸣，1 例切口感染，1 例咽瘘，1 例假声（经嗓音训练纠正）。无患者发生喉血肿、颈部血肿或喉痉挛。
结论
改良杓状软骨内收加甲状软骨开窗术可显著改善单侧声带麻痹患者的嗓音功能，有效减少吸入，术后并发症少，创伤小，操作更方便。
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