| BackgroundBilateral vocal cord paralysis(BVCP)is a disease that can affect breathing,sound,and swallowing,which can seriously affect quality of life and even threaten life.It refers to vocal cord dyskinesia caused by dysfunction of recurrent laryngeal nerve,and it is necessary to exclude vocal cord fixation caused by dislocation of the cricoarytenoid joint and tumor invasion of vocal cord muscles.There are many causes of BVCP,including space-occupying lesions,iatrogenic injuries,trauma,inflammation,idiopathic,etc[1-3].The most common cause is after thyroidectomy,especially after Secondary surgery.The second most common cause is tumor[4].As the use of recurrent laryngeal nerve monitoring instruments has become more widespread in clinical practice,the number of patients with VCP has decreased.Patients with BVCP may experience some symptoms such as dyspnea,throat wheezing,decreased tone,hoarseness,aspiration,and even choking[5,6].The main surgical methods of BVCP include arytenoidectomy,laterofixation[7],and cordotomy[8].In terms of the clinical efficacy of surgery,the reports were inconsistent,and there is currently no consensus on which is the most suitable surgical approach clinically.ObjectiveTo explore the clinical efficacy in the treatment of BVCP by comparing unilateral arytenoidectomy through larngofissure with endoscopic coblation unilateral arytenoidectomy.MethodsA retrospective analysis of 68 patients with BVCP who underwent surgical treatment in our hospital from January 2014 to May 2019.Of these,31 patients underwent unilateral arytenoidectomy by larngofissure,and 37 patients underwent low-temperature plasma unilateral arytenoidectomy under laryngoscope.The follow-up period was 6 to 62 months.The operation time,intraoperative blood loss and post-extubation rate were recorded.According to the Voice Handicap Index Questionnaire Self-Assessment Scale,the VHI values of patients who were successfully extubated and had the operation after 6 months were recorded.According to the degree of aspiration,the condition of postoperative aspiration was recorded.To compare the surgical conditions,the improvement conditions of breath,sound quality and swallowing function of the two surgical methods to evaluate the surgical efficacy.Results1.The larngofissure group had a longer operation time than the endoscopic group,and there was more intraoperative blood loss.The discrepancy was statistically significant(P<0.05).2.The extubation rate of the larngofissure group was 87.1%.The extubation rate of the endoscopic group was 91.9%.The discrepancy of the extubation rate was not statistically significant(P>0.05).3.The postoperative larngofissure group had a VHI value greater than that before surgery,and the discrepancy was statistically significant(P<0.05).The postoperative endoscopic group had a higher VHI value than that before surgery,and the discrepancy was significant(P<0.05).The VHI value after surgery of the laryngofissure group was greater than that of the endoscopic group,and the discrepancy was statistically significant(P<0.05).4.According to the degree of aspiration at 1 day,2 weeks and 2 months after surgery,the degree of aspiration in the larngofissure group was similar to the endoscope group,and the discrepancy was not statistically significant(P>0.05).ConclusionEndoscopic coblation assisted unilateral arytenoidectomy has a high extubation rate,minor damage to the laryngeal function,simple operation,short operation time,and less bleeding,which is worthy to apply in clinics.Unilateral arytenoidectomy by larngofissure also has a high extubation rate,but the trauma was more serious and the voice decreased more obviously after operation,which can be adopted by hospitals who only have basic surgical equipments,and can be selected for patients who have difficulty in supporting exposure under laryngoscope. |
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