内镜下杓状软骨外展侧固定术联合杓状软骨旁软组织减容术治疗永久性双侧声带麻痹
Endoscopic arytenoid abduction lateropexy with para-arytenoid soft tissue reduction for the treatment of permanent bilateral vocal fold palsy.
文献信息
| PMID | 42747523 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | László Rovó |
| 作者单位 | Department of Otorhinolaryngology - Head and Neck Surgery, Albert Szent- Györgyi Faculty of Medicine, University of Szeged, Tisza Lajos krt. 111, Szeged, 6725, Hungary. |
| 期刊 | European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery |
| SCI 分区 | Q1 |
| IF | 2.3 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 内镜下杓状软骨外展侧固定术（EAAL）是治疗双侧声带麻痹（BVFP）的一种可靠、微创的技术。本研究旨在评估一种改良EAAL方法的安全性和功能疗效，该方法使用可吸收缝线和CO₂激光杓状软骨旁软组织减容术，以实现持久的外展，而无需长期使用异物材料。
方法： 本研究纳入了15例甲状腺手术后永久性BVFP患者，其中包括8例既往接受过声门扩大手术后再次手术的病例。该技术包括在软组织减容后使用可吸收缝线暂时固定杓状软骨，并在需要时行环杓关节脱位。在术前以及术后1个月和12个月评估吸气峰流量（PIF）、最长发声时间（MPT）、嗓音障碍指数（VHI）和喉功能特异性生活质量（QoL）。采用纤维内镜吞咽评估（FEES）和MD Anderson吞咽困难量表（MDADI）问卷评估吞咽功能。
结果： 所有患者均立即获得稳定且持久的气道，无围手术期并发症。平均PIF在术后显著增加，并在12个月时保持稳定。MPT在两个术后时间点均无显著变化。VHI在整个随访期间显著改善。MDADI评分在早期改善，并持续显著高于基线。QoL在术后早期显著改善，并在12个月时仍显著升高。FEES显示13/15例患者吞咽生理性。缝线相关症状在缝线吸收后消退。
结论： 联合软组织减容术的改良EAAL提供了稳定的气道，同时维持了发声和吞咽功能。暂时性固定通过声门旁瘢痕形成确保持久的外展，从而最大限度地减少了长期异物相关并发症。
英文摘要
PURPOSE: Endoscopic arytenoid abduction lateropexy (EAAL) is a reliable, minimally invasive technique for treating bilateral vocal fold palsy (BVFP). This study aimed to evaluate the safety and functional efficacy of a modified approach for EAAL that utilizes absorbable sutures and CO₂-laser para-arytenoid soft tissue reduction to achieve durable lateralization without the long-term use of foreign materials.
METHODS: This study enrolled 15 patients with permanent BVFP following thyroid surgery, including 8 revisions after prior glottis-widening procedures. The technique involved temporary arytenoid fixation with an absorbable suture after soft tissue reduction and, when required, cricoarytenoid joint disarticulation. Peak inspiratory flow (PIF), maximum phonation time (MPT), Voice Handicap Index (VHI), and laryngeal function-specific quality-of-life (QoL) were assessed before and 1 and 12 months after surgery. Deglutition function was evaluated with fiberoptic endoscopic evaluation of swallowing (FEES) and the MD Anderson Dysphagia Inventory (MDADI) questionnaire.
RESULTS: All patients immediately achieved a stable and durable airway without perioperative complications. Mean PIF increased significantly after surgery and remained stable at 12 months. MPT showed no significant change at either postoperative timepoint. VHI improved significantly throughout follow-up. MDADI scores improved early and remained significantly above baseline. QoL improved markedly in the early postoperative period and remained significantly increased at 12 months. FEES revealed physiological swallowing in 13/15 patients. Suture-related symptoms resolved after suture absorption.
CONCLUSION: The modified EAAL with soft tissue reduction provides a stable airway while maintaining phonatory and swallowing functions. Temporary fixation ensures durable lateralization via paraglottic scarring, thereby minimizing long-term foreign body-related morbidity.