Orb Quinn, Dunya Gabriel, Padia Reema, King Jerald, Holbrook John, Muntz Harlan, Smith Marshall E
Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA.
Department of Otolaryngology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Laryngoscope. 2023 May;133(5):1257-1261. doi: 10.1002/lary.30343. Epub 2022 Aug 20.
In patients undergoing patent ductus arteriosus (PDA) ligation there is a significant risk of left vocal fold paralysis (LVFP) particularly in premature neonates who are small for gestational age. The objective of this study is to determine the incidence of LVFP in infants following PDA ligation and report on long-term outcomes in patients with LVFP.
We performed a prospective study of patients undergoing PDA ligation in the newborn intensive care unit (NICU) between April 2004 and May 2014. Following PDA ligation, flexible laryngoscopy was performed to assess vocal fold mobility. Patients were then followed longitudinally to determine long-term outcomes.
A total of 163 infants underwent PDA ligation. Thirty-six patients (22%) developed LVFP following the procedure. Twenty-five percent of neonates <1500 g experienced LVFP versus 5% of patients >1500 g (p = 0.033). Patients with LVFP were more likely to require a feeding tube (64% vs. 19.6%; p < 0.05) and spent more time in the NICU (135 days vs. 106 days; p < 0.05). Twenty-four patients received long-term follow-up. Six (25%) had complete resolution of LVFP, 10 (42%) were compensated, and 8 (33%) demonstrated persistent LVFP with no improvement.
The incidence of LVFP after PDA ligation is high especially in extremely low birth weight children. The majority of patients recovered well with time, but further surgical intervention was required in uncompensated cases. Long-term follow-up of these patients is needed to ensure improvement. Laryngoscope, 133:1257-1261, 2023.
在接受动脉导管未闭（PDA）结扎术的患者中，尤其是孕周小的早产儿，存在左声带麻痹（LVFP）的重大风险。本研究的目的是确定婴儿PDA结扎术后LVFP的发生率，并报告LVFP患者的长期预后。
我们对2004年4月至2014年5月在新生儿重症监护病房（NICU）接受PDA结扎术的患者进行了一项前瞻性研究。PDA结扎术后，进行纤维喉镜检查以评估声带活动度。然后对患者进行纵向随访以确定长期预后。
共有163例婴儿接受了PDA结扎术。36例患者（22%）术后发生LVFP。体重<1500g的新生儿中有25%发生LVFP，而体重>1500g的患者中这一比例为5%（p = 0.033）。LVFP患者更有可能需要鼻饲管（64%对19.6%；p<0.05），且在NICU住院时间更长（135天对106天；p<0.05）。24例患者接受了长期随访。6例（25%）LVFP完全缓解，10例（42%）得到代偿，8例（33%）表现为持续性LVFP且无改善。
PDA结扎术后LVFP的发生率很高，尤其是极低出生体重儿。大多数患者随时间推移恢复良好，但未得到代偿的病例需要进一步手术干预。需要对这些患者进行长期随访以确保病情改善。《喉镜》，2023年，第133卷，第1257 - 1261页
