Department of Otolaryngology, Shenzhen Children's Hospital, Shenzhen, China; Zunyi Medical University, Zuyi, China.
Department of Otolaryngology, Shenzhen Children's Hospital, Shenzhen, China.
Am J Otolaryngol. 2022 May-Jun;43(3):103380. doi: 10.1016/j.amjoto.2022.103380. Epub 2022 Feb 2.
To explore the novel technique of percutaneous endoscopic suture lateralization for bilateral vocal cord paralysis (BVCP) in neonates from Shenzhen, China, and to evaluate the safety and efficacy of the operation.
In this retrospective case series, we present four neonates with BVCP diagnosed within 3 days after birth from Shenzhen Children's Hospital. All had stridor, respiratory distress and hypoxemia requiring respiratory support at diagnosis. Endoscopic vocal fold lateralization was performed under general anesthesia using 3.0 mm endotracheal intubation through the improved technique of percutaneous needle-directed placement of a 4-0 Prolene suture, without the use of specialized equipment. A 4-0 Prolene wire was led out through two 10 ml syringe needles, the left vocal cord was fully moved and fixed under the skin with endoscopy monitoring.
Overall, 3/4 of the patients showed clinical improvement in stridor and dyspnea 2-3 weeks after the operation and avoided a tracheostomy, two of them could breathe and feed normally when they were discharged from hospital, and one patient had a weak ability to suck but could breathe normally. The last patient had to undergo a tracheotomy due to the poor improvement in respiratory distress. None of the babies experienced any complications from this surgery, but case four presented with a series of complications and other problems in postoperative care related to the tracheostomy. At the last follow-up (mean 8 months), complete function of the bilateral vocal cords was acquired in case two (6 months) and partial function of the vocal cords was acquired in case one (13 months), with the other cases still experiencing paralysis.
Endoscopic percutaneous suture lateralization may be a reversible, effective and minimally invasive primary treatment for neonatal BVCP. Most of neonates with BVCP undergoing this procedure avoided a tracheotomy.
探索中国深圳用于治疗新生儿双侧声带麻痹（BVCP）的经皮内镜缝合法新技术，并评估该手术的安全性和疗效。
本回顾性病例系列研究纳入了 2019 年 1 月至 2021 年 12 月期间在深圳市儿童医院确诊为双侧声带麻痹且在出生后 3 天内接受治疗的 4 例新生儿。所有患儿在诊断时均存在喘鸣、呼吸窘迫和低氧血症，需要呼吸支持。在全身麻醉下，使用 3.0mm 气管插管，通过改良的经皮针定向放置 4-0 prolene 缝线的技术进行内镜声带侧移，不使用专门的设备。将一根 4-0 prolene 缝线通过两根 10ml 注射器针头引出，在内镜监测下，将左侧声带完全移动并固定在皮肤下。
总的来说，3/4 的患者在术后 2-3 周时在喘鸣和呼吸困难方面有临床改善，避免了气管切开术，其中 2 例在出院时可以正常呼吸和进食，1 例吸吮能力较弱但呼吸正常。最后 1 例患者因呼吸困难改善不佳而需要进行气管切开术。所有婴儿均未出现手术相关并发症，但病例 4 在术后护理过程中出现了一系列并发症和与气管切开术相关的其他问题。在最后一次随访（平均 8 个月）时，病例 2 的双侧声带功能完全恢复（6 个月），病例 1 的声带部分恢复（13 个月），而其他病例仍存在麻痹。
经皮内镜缝线侧移术可能是治疗新生儿双侧声带麻痹的一种可逆、有效且微创的首选治疗方法。大多数接受该手术的新生儿避免了气管切开术。
