Clinical research of unilateral posterior glottic cleft dilatation in the treatment of bilateral vocal cord paralysis dyspnea
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摘要: 目的 评估内镜下应用低温等离子行单侧声门后裂扩大术治疗双侧声带麻痹呼吸困难的疗效。方法 对郑州大学第一附属医院耳鼻咽喉头颈外科2014年3月—2019年6月收治的41例双侧声带麻痹患者，采用低温等离子完整切除单侧杓状软骨及同侧声带后1/3，手术前后行纤维喉镜检查，评估声门裂大小及患者术后呼吸困难改善率、嗓音满意程度、吞咽功能、气管套管拔出率、术后并发症发生率，评估该手术的临床疗效。结果 随访24~88个月，一次性拔管率为88.57%(31/35)，嗓音满意率为92.11%(35/38)，吞咽功能恢复率为97.56%(40/41)。结论 应用低温等离子行单侧声门后裂扩大术能明显改善双侧声带麻痹患者的通气功能，疗效可靠，拔管率高，是治疗双侧声带麻痹的一种安全、可靠、简单、微创的治疗选择。Abstract: Objective The aim of this study is to evaluate the efficacy of unilateral posterior glottic cleft dilatation with low-temperature plasma under the endoscope in the treatment of bilateral vocal cord paralysis dyspnea.Methods Forty-one patients with bilateral vocal cord paralysis were recruited, and they were all admitted to the Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Zhengzhou University from March 2014 to June 2019. Those 41 patients were all treated with low-temperature plasma to completely resect unilateral arytenoid cartilage and the posterior 1/3 of the ipsilateral vocal cord. Fiber laryngoscopy was performed before and after operation. The clinical efficacy of the operation was evaluated by the size of glottis cleta, the improvement rate of dyspnea, voice satisfaction, swallowing function, the tracheal cannula removal rate and postoperative complication rate.Results Forty-one patients were followed up for 24-88 months. The rate of one-pass extubation was 88.57%(31/35). The satisfaction rate of voice was 92.11%(35/38). The recovery rate of swallowing function was 97.56%(40/41).Conclusion This study demonstrated that the application of low-temperature plasma in unilateral posterior glottic cleft dilatation could significantly improved the ventilation function of patients with bilateral vocal cord paralysis, with a reliable curative effect and a high extubation rate. It is a safe, reliable, simple and minimally invasive treatment option for the treatment of bilateral vocal cord paralysis.
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