儿童双侧声带麻痹激光手术2例并文献复习  

Laser surgery for bilateral vocal cord paralysis in children:2 cases report and literature review

作　　者：程超 周宜龙 刘大波 庄佩耘[3] CHEN Chao;ZHOU Yilong;LIU Dabo;ZHUANG Peiyun(Department of Otolaryngology,Longgang E.N.T.Hospital&Shenzhen Key Laboratory of E.N.T,Shenzhen,510000,China;Department of Pediatric Otorhinolaryngology,Shenzhen Hospital,Southern Medical University;Department of Voice,Zhongshan Hospital of Xiamen University,School of Medicine,Xiamen University)

机构地区：[1]深圳市龙岗区耳鼻咽喉医院耳鼻咽喉科,广东深圳510000 [2]南方医科大学深圳医院儿童耳鼻咽喉科 [3]厦门大学附属中山医院嗓音科

出　　处：《临床耳鼻咽喉头颈外科杂志》2025年第2期173-176,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：声带麻痹(VCP)是指支配喉内肌群的运动神经传导通路受损导致声带的运动障碍,可同时伴有喉的感觉神经障碍。双侧声带麻痹的症状主要为哭声嘶哑、吸奶呛咳、喉喘鸣,严重时可致窒息。我科近期采用CO_(2)激光对此类患儿展开治疗,但两者的预后却有明显的差异。病例1为2岁男性,主诉“气管切开术后2年”来诊。患儿出生后诊断“双侧声带麻痹伴Ⅱ度喉梗阻”,在本地医院接受了气管切开术,并维持气管造口至今。电子喉镜检查显示:双侧声带固定于旁正中位,声门裂隙约1 mm,未见明显外展运动。在我科行手术治疗后效果良好,随访至今无复发。病例2为1岁女性,主诉“气管切开术后1年余”就诊,患儿诊断:(1)双侧声带麻痹;(2)喉软化症;(3)新生儿肺炎。在外院接受了气管切开术,并自此维持气管造口状态。电子喉镜检查示双侧声带内收固定,声门裂隙约0.5 mm,声带外展受限。患儿术后效果不佳,未能拔管。Vocal cord paralysis(VCP)refers to the movement disorder of the vocal cord caused by the damage of the motor nerve conduction pathway that dominates the laryngeal muscles,which can be accompanied by sensory nerve disorder of the larynx.Symptoms of bilateral vocal cord paralysis include crying hoarseness,sucking cough,and laryngeal stridor,which can lead to asphyxia in severe cases.Our team recently used CO2 laser to treat such children,but the prognosis varies significantly.Case 1:A 2-year-old male,who had undergone tracheotomy 2 years prior,was diagnosed with"bilateral vocal cord paralysis with grade Ⅱ laryngeal obstruction"after birth.He maintained a tracheostomy until recently.Electronic laryngoscopy showed that the bilateral vocal cords were fixed in the midline,with a glottic fissure of about 1 mm.After surgical treatment,the outcome was good,and there was no recurrence during follow-up.A 1-year-old female,who had undergone tracheotomy over a year ago,was diagnosed with'①bilateral vocal cord paralysis;②laryngomalacia;③neonatal pneumonia.'She maintained a tracheostomy since then.Electronic laryngoscopy revealed that the bilateral vocal cords were retracted and fixed,with a glottic fissure of about 0.5 mm and limited vocal cord abduction.The postoperative outcome for this child was not good,and the tracheostomy tube was not removed.

关 键 词：儿童 双侧声带麻痹 预后 

分 类 号：R767.4[医药卫生—耳鼻咽喉科]