Eckel H E, Thumfart M, Wassermann K, Vössing M, Thumfart W F
Department of Otorhinolaryngology, University of Cologne, Germany.
Ann Otol Rhinol Laryngol. 1994 Nov;103(11):852-7. doi: 10.1177/000348949410301105.
Our objective was to assess the effectiveness of transoral laser cordectomy and laser arytenoidectomy and to compare the results with a view to respiratory and phonatory function and deglutition. Twenty-eight patients with bilateral vocal cord paralysis were included in a prospective study. Eighteen patients had cordectomy, and 10, arytenoidectomy. Lung function tests and voice analysis were performed preoperatively and postoperatively. Subclinical aspiration was determined by endoscopic evaluation of the larynx during deglutition. The results were compared to determine the relative effectiveness of both surgical methods. Flow volume spirograms documented equally improved flow rates in both groups. The final voice evaluation revealed that maximum phonation time, peak sound pressure levels, and frequency range were reduced in all 28 patients, but the phonatory results varied considerably in each group. Subclinical aspiration was noticed in 5 of 10 patients after arytenoidectomy, but in none of 18 patients after cordectomy. Four of 6 previously tracheostomized patients were decannulated within 2 weeks after surgery, while the other 22 patients had no perioperative tracheostomies. We conclude that transoral laser cordectomy and arytenoidectomy are equally effective and reliable in the management of the restricted airway. Phonatory outcome is not predictable with either surgical procedure. Cordectomy is easier and faster to perform, and subclinical aspiration is not encountered with this procedure.
我们的目的是评估经口激光声带切除术和激光杓状软骨切除术的有效性，并比较两者在呼吸、发声功能及吞咽方面的结果。28例双侧声带麻痹患者纳入一项前瞻性研究。18例行声带切除术，10例行杓状软骨切除术。术前及术后进行肺功能测试和嗓音分析。通过吞咽时喉镜的内镜评估确定亚临床误吸情况。比较结果以确定两种手术方法的相对有效性。流量容积图显示两组流速均有同等程度改善。最终的嗓音评估显示，28例患者的最长发声时间、峰值声压级和频率范围均降低，但每组的发声结果差异很大。杓状软骨切除术后10例患者中有5例出现亚临床误吸，而声带切除术后18例患者中无一例出现。6例先前行气管切开术的患者中有4例在术后2周内拔管，另外22例患者未行围手术期气管切开术。我们得出结论，经口激光声带切除术和杓状软骨切除术在处理气道受限方面同样有效且可靠。两种手术方式的发声结果均不可预测。声带切除术操作更简便、更快，且该手术不会出现亚临床误吸。
