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目的:探讨支撑喉镜显微镜下激光单侧杓状软骨切除治疗双侧声带麻痹的手术方法、并发症及疗效。方法:对1999年9月至2003年2月16例双侧声带麻痹患者在支撑喉镜显微镜下行全麻半导体激光右侧杓状软骨切除术,术中调整激光功率为8W,脉冲0.6～0.8s,间隔0.2s。其中3例患者术后5～7d行纤维喉镜下同侧声带后部激光部分切除术。结果:14例患者在术后2个月内拔除气管套管,经1年以上随访,无呼吸困难及创面肉芽生长;另1例患者杓间区见瘢痕增生,堵管9个月后拔管。该15例拔管患者的术后声门最大开放面积为(45.93±6.56)mm2,声门后部最大横径为(4.97±0.73)mm。另1例术后41d再次出现Ⅱ度呼吸困难,检查发现术区及后联合处有大量肉芽生长。结论:支撑喉镜显微镜下激光杓状软骨适当范围的切除既能有效地解除呼吸困难,又能获得术后较好的嗓音;术中控制激光功率及激光暴露时间能减少并发症。
Objective: To investigate the surgical methods, complications and curative effects of laser unilateral arytenoid articular cartilage resection for bilateral vocal cord paralysis under the laryngoscope. Methods: From September 1999 to February 2003, 16 patients with bilateral vocal cord paralysis underwent general anesthesia laser laryngotracheal resection under the support of laryngoscope. The intraoperative laser power was adjusted to 8W and pulse 0.6 ~ 0.8s , Interval 0.2s. Three of them underwent partial laparotomy of the posterior part of the ipsilateral vocal cord under laryngoscope 5 to 7 days after operation. Results: In 14 patients, tracheal cannula was removed within 2 months after operation. No dyspnea and granulation of wound were observed after more than one year follow-up. In another patient, scarred hyperplasia was observed in the inter-penile area. Extubation was performed 9 months later . The maximal open glottic area of the 15 patients with extubation was (45.93 ± 6.56) mm2, and the largest transverse diameter of the glenoid anterior chamber was (4.97 ± 0.73) mm. Another case of 41d again after the second degree of dyspnea, examination found that there are a large number of postoperative granulation and joint growth. CONCLUSIONS: The removal of the proper range of laser arytenoid cartilage under the support laryngoscope can effectively relieve dyspnea and obtain better postoperative voice. The intraoperative control of laser power and laser exposure time can reduce the complications.