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目的 探讨单侧喉返神经损伤声带麻痹时喉返神经探查减压术和喉返神经端端吻合术的疗效及适应证。 方法 病程半年以内外伤性喉返神经损伤声带麻痹患者 42例,分为神经减压组 15例、喉返神经端端吻合组 6例、保守治疗组 21例。神经减压组为神经探查术中发现喉返神经缝线结扎、瘢痕压迫,予以松解。治疗前后以喉镜、嗓音声学参数、肌电图检查等评价手术效果。 结果 神经减压组,病程 4个月内神经减压 13例中 11例不同程度恢复声带内收及外展功能;另 2例及病程 4个月以上减压的 2例,声带虽未恢复运动功能,但恢复了正常的肌张力、肌体积,声带振动及黏膜波对称,嗓音亦恢复正常。喉返神经端端吻合组喉内收肌也获得了神经再支配,声音基本恢复正常,但声带均未恢复运动功能。保守治疗组声嘶有改善,但声带运动功能未恢复。肌电图检查进一步证实神经减压组喉功能恢复最佳。 结论 早中期喉返神经探查减压能恢复麻痹声带正常的运动功能,喉返神经端端吻合术使喉内收肌获得了神经再支配,声音基本恢复正常。
Objective To investigate the curative effect and indications of decompression of the recurrent laryngeal nerve and anastomosis of recurrent laryngeal nerve in vocal cord paralysis with unilateral recurrent laryngeal nerve injury. Methods 42 cases of vocal cord paralysis with traumatic recurrent laryngeal nerve injury within half a year were divided into 15 cases of nerve decompression group, 6 cases of anastomosis of recurrent laryngeal nerve and 21 cases of conservative treatment group. Nerve decompression group for nerve exploration found in the recurrent laryngeal nerve suture ligation, scar compression, be loosen. Before and after treatment with laryngoscopy, voice acoustics parameters, electromyography and other evaluation of surgical results. Results In the decompression group, 11 cases of nerve decompression within 4 months were restored with different degrees of adduction and abduction of vocal cord. In the other 2 cases and 2 cases whose duration of decompression was over 4 months, the vocal cord did not recover Function, but restored the normal muscle tone, muscle volume, vocal cord vibration and mucosal wave symmetry, the voice also returned to normal. Recurrent laryngeal nerve end-to-end laryngeal adductor muscle also received nerve re-dominance, the sound returned to normal, but the vocal cord were not restored motor function. Conservative treatment group improved hoarseness, but vocal cord motor function did not recover. Electromyography further confirmed that nerve decompression laryngeal function best recovery. Conclusions Early decompression of recurrent laryngeal nerve can restore the normal motor function of paralyzed vocal folds. The recurrent laryngeal nerve anastomosis rehabilitated the laryngeal adductor muscle and the sound returned to normal.