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目的探讨杓状软骨内移联合颈袢喉返神经吻合术治疗长期喉返神经损伤单侧声带麻痹的疗效。方法病程3～22年外伤性喉返神经损伤单侧声带麻痹患者12例,行患侧杓状软骨内移的同时,作颈袢喉返神经吻合术。治疗前后以电子喉镜、频闪喉镜、声音评估、嗓音声学参数分析和喉肌电图检查等评价治疗效果。结果所有患者杓状软骨内移术后即刻声嘶均明显好转,但无恢复正常者,声学四参数频率微扰、振幅微扰、标化噪音能量和最长发声时间分析均明显好转,差异均有显著性意义(P值均<0.05);喉镜检查见杓状软骨明显内移,声门后裂隙消失9例,缩小3例。术后12个月时声音恢复正常、明显好转、好转、无改善分别为9、3、0、0例;声学四参数较术后即刻又有明显好转,差异均有显著性意义(P值均<0.05);术侧声带虽未恢复运动,但肌张力和肌体积与健侧基本对称。肌电图检查显示术后12个月声带肌恢复与健侧同步的密集型自发电位。结论杓状软骨内移联合颈袢喉返神经吻合治疗长期喉返神经损伤单侧声带麻痹能恢复患者的正常发音功能。
Objective To investigate the efficacy of arytenoid cartilage internal fixation combined with rectal nerve anastomosis in the treatment of unilateral vocal cord paralysis after long-term recurrent laryngeal nerve injury. Methods During the period of 3 ~ 22 years, 12 cases of unilateral vocal cord paralysis with traumatic recurrent laryngeal nerve injury were treated with anastomosis of the recurrent nerve of neck and laryngeal nerve while moving the arytenoid cartilage. Before and after treatment with electronic laryngoscope, laryngoscope, voice assessment, voice acoustic parameters analysis and laryngeal electromyography examination evaluation of treatment. Results All patients had a significant improvement of hoarseness immediately after the arytenoid endarterectomy, but no return to normal, four-parameter acoustics frequency perturbation, amplitude perturbation, normalized noise energy and longest vocalization time were significantly improved, the differences were (P <0.05). In laryngoscopy, the arytenoid cartilage was obviously moved inwards, disappearance of glottic fissure in 9 cases and narrowing in 3 cases. At 12 months after operation, the sound returned to normal, with marked improvement and improvement without improvement of 9, 3, and 0, respectively. Acoustic parameters were significantly improved immediately after operation, with significant differences (P values <0.05). Although the vocal cord at the operative side did not recover, the muscle tone and muscle volume were basically symmetrical with the contralateral side. EMG examination showed that the vocal cord muscle at 12 months postoperatively recovered intensive spontaneous potentials synchronized with the contralateral side. CONCLUSIONS: The treatment of chronic recurrent laryngeal nerve injury unilateral vocal cord paralysis can restore normal phonation function of the arytenoid cartilage endarterectomy and ankle reentry anastomosis.