半膈神经转位修复喉返神经治疗双侧声带麻痹  

Treatment of bilateral vocal cord paralysis by hemi-phrenic nerve transfer

作　　者：宋伟[1] 李孟[1] 郑宏良[1] 孙丽[1] 陈世彩[1] 陈东辉[1] 刘菲[1] 朱敏辉[1] 张才云[1] 王伟[1] 

机构地区：[1]第二军医大学长海医院耳鼻咽喉头颈外科,上海200433

出　　处：《中华耳鼻咽喉头颈外科杂志》2017年第4期245-252,共8页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的比较一侧半膈神经神经再支配双侧环杓后肌神经修复手术与内镜下激光杓状软骨切除声带外移术治疗双侧喉返神经损伤的效果差异。方法2009年1月至2015年12月期间，收集117例甲状腺手术后双侧喉返神经损伤声带麻痹的患者，分为神经组（52例）和激光组（65例），分别采用一侧半膈神经神经再支配双侧环杓后肌神经修复手术和内镜激光杓状软骨切除声带外移术。手术前后通过嗓音主客观指标总嘶哑度（G）、Jitter、Shimmer、噪谐比、动态喉镜、肺功能、喉肌电图等检查，并比较拔管率，分析评估临床疗效。结果神经组术后大多数嗓音功能指标较术前有改善，但差异无统计学意义（P均〉0.05）；激光组术后较术前变差，差异均有统计学意义（P均〈0.05）；神经组术后的嗓音主客观指标优于激光组，差异有统计学意义（P均〈0.05）。两组术后术侧声带位置较术前均有显著性外移（P〈0.05），但神经组声带外移幅度大于激光组（P〈0.05），且神经组89%的患者属吸气性生理性的声带外展运动。神经组发声时声带内收，但声门闭合度与术前比较差异无统计学意义（P〉0.05）；而激光组术后的声门闭合度较术前明显增大，差异有统计学意义（P〈0.05）；神经组的术后声门闭合度小于激光组，差异有统计学意义（P〈0.05）。术后3个月时神经组肺功能与术前无明显差异，6个月时二组的肺功能均好于术前，差异有统计学意义（P〈0.05）。术后喉肌电图检查结果证实神经组双侧环杓后肌恢复了正常的神经再支配。两组一次手术拔管率分别为88.5%（46/52）和81.5%（53/65），差异无统计学意义（P〉0.05）。术后两组均表现出不同程度的误吸，但神经组恢复时间短，程度轻。结论采用一侧半膈神经转位神经再支配双侧环杓后肌能使双侧声带恢复满意的生理性外展Objective To investigate the surgical effect of reinnervation of bilateral posterior cricoarytenoid muscles （PCA） with left hemi-phrenic nerve and endoscopic laser arytenoid resection in bilateral vocal cord fold paralysis（BVFP） and to analyze the pros and cons of the two methods. Methods One hundred and seventeen BVFP patients who underwent reinnervation of bilateral PCA using the left hemi- phrenic nerve approach （ nerve group, n = 52） or laser arytenoidectomy （ laser group, n = 65 ） were enrolled in this study from Jan. 2009 to Dee. 2015. Vocal perception evaluation, video stroboscopy, pulmonary function test and laryngeal electromyography were preformed in all patients both preoperatively and postoperatively. Extubution rate was calculated postoperatively. Results Most of the vocal function parameters in nerve group were improved postoperatively compared with preoperative parameters, albeit without a significant difference （ P 〉 0. 05 ）, while laser group showed a significant deterioration in voice quality postoperatively （P 〈 0.05 ）. The two groups showed significant difference in voice quality postoperatively（P 〈 0. 05 ）. Videostroboseopy showed that vocal fold on the operated side in both groups could abduct to various extent postoperatively, which showed significant difference when compared with preoperative abduetive movements （ P 〈 0. 05 ）. But the amplitude in nerve group was larger than that in laser group （P 〈 0. 05 ）. 89% of the patients in nerve group were inhale physiological vocal cord abductions. Postoperative glottal closure showed no significant difference in nerve group （P 〉 0. 05 ）, while showed various increment in laser group（ P 〈 0. 05 ）. Differences between the two groups were statistically significant （ P 〈 0. 05 ）. The pulmonary function in both groups was better after operation, reaching the reference value. Postoperative laryngeal electromyography confirmed successful reinnervation of the bilateral PCA muscles. The decan

关 键 词：声带麻痹 喉返神经 膈神经 神经修复 

分 类 号：R767.91[医药卫生—耳鼻咽喉科]