使用Lichtenberger持针器对双侧声带麻痹新生儿和婴儿进行内镜下声带外侧化术：单中心病例系列研究

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中文摘要

背景： 双侧声带麻痹（BVFP）是新生儿和婴儿呼吸窘迫的一种罕见但可能危及生命的病因。尽管气管切开术传统上是严重气道梗阻的标准治疗方法，但已开发出创伤较小的手术替代方案以避免相关并发症。内镜下声带外侧化术（EVFLA）就是其中一种方法。
目的： 评估使用Lichtenberger持针器进行EVFLA作为气管切开术替代方案，在因BVFP导致呼吸窘迫的新生儿和婴儿中的安全性和有效性。
方法： 这项回顾性单中心研究纳入了2017年1月至2025年1月期间在一家三级儿科气道中心接受EVFLA的8名6个月以下婴儿。所有患者均表现为需要无创通气（NIV）的显著呼吸窘迫。收集了术前、围手术期和术后数据，最短随访时间为12个月。主要结局是术后是否需要气管切开术。次要结局包括通气状态、喂养结局、并发症、再次干预和发声困难。
结果： 气管切开避免率为100%。术后插管中位持续时间为1天，术后持续NIV的中位持续时间为1.5天。在末次随访时，6名患者实现了完全经口喂养，而仅1名患者观察到持续性临床误吸。3名患者因轻微并发症需要修正手术，包括喉水肿、缝线松动、轻度声门粘连。3名患者报告了发声困难。没有患者出现声带结构性损伤。
结论： 使用Lichtenberger持针器进行EVFLA可能是BVFP相关气道梗阻新生儿中一种安全、有效、微创的气管切开术替代方案。

英文摘要

BACKGROUND: Bilateral vocal fold paralysis (BVFP) is a rare but potentially life-threatening cause of respiratory distress in newborns and infants. Although tracheotomy has traditionally been the standard treatment for severe airway obstruction, less invasive surgical alternatives have been developed to avoid associated morbidity. Endoscopic vocal fold lateralization (EVFLA) represents one such approach.
OBJECTIVE: To evaluate the safety and efficacy of EVFLA using the Lichtenberger needle holder as an alternative to tracheotomy in neonates and infants with respiratory distress caused by BVFP.
METHODS: This retrospective, single-center study included 8 infants younger than 6 months who underwent EVFLA between January 2017 and January 2025 at a tertiary pediatric airway center. All patients presented with significant respiratory distress requiring non-invasive ventilation (NIV). Preoperative, perioperative, and postoperative data were collected, with a minimum follow-up of 12 months. Primary outcome was the need for tracheotomy following surgery. Secondary outcomes included ventilatory status, feeding outcomes, complications, reinterventions, and dysphonia.
RESULTS: Tracheotomy avoidance rate was 100%. Median duration of postoperative intubation was 1 day, median duration of continuous postoperative NIV was 1.5 days. At final follow-up, 6 patients achieved exclusive oral feeding, while persistent clinical aspiration was observed in only 1 patient. Three patients required revision surgery because of minor complications, including laryngeal edema, suture loosened, mild glottic synechia. Dysphonia was reported in 3 patients. No patient experienced structural damage to the vocal folds.
CONCLUSIONS: EVFLA using the Lichtenberger needle holder may represent a safe, effective, minimally invasive alternative to tracheotomy in newborns with BVFP-related airway obstruction.