Videolaryngoscopic assessment of laryngeal edema after arytenoid adduction
Videolaryngoscopic assessment of laryngeal edema after arytenoid adduction
复制标题
视频喉镜评估杓状软骨内收后喉头水肿
DOI：
10.1002/lary.23241
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发表时间：
2012
期刊：
影响因子：
2.6
通讯作者：
Narajos N
中科院分区：
文献类型：
--
作者：
今泉光雅;大森孝一;他;Narajos N
目的/假设杓状软骨内收术（AA）作为单侧声带麻痹（UVFP）的手术治疗，与其他喉支架手术相比，术后喉水肿导致气道并发症的发病率较高。本研究的目的是评估术后喉水肿AA后使用一种新的视频喉镜（VL）评分assessment.Study Design前瞻性cases series.Methods19例UVFP患者（14名男性和5名女性;平均年龄，56岁）与AA单独或结合颈袢（AA/AC）神经吻合术或神经肌肉蒂（AA/NMP）皮瓣植入进行了评价。术后10天通过VL评分评估喉水肿。水肿程度在三个亚部位进行评分：手术侧的膜状声带、杓状软骨丘和梨状窦。统计学意义P <0.05。结果术后无一例发生气道损伤。检查者间的信度一般较高（Spearmanr> 0.75）。平均水肿程度从术后第1天（POD）至第3天稳步增加，在所有子部位的POD 3达到峰值。然后从POD 3至7显著下降（P<0.05），并逐渐通过POD 10。在任何子部位，最大水肿程度、最大水肿时间和手术时间均无显著相关性。最大水肿时间和手术类型（AA vs. AA/AC或AA/NMP）在任何子站点均不相关。VL结果表明，AA单独或AA结合神经再支配显示最大喉水肿的POD 3，但没有增加显着的发病率。
Objectives/HypothesisArytenoid adduction (AA) as surgical treatment for unilateral vocal fold paralysis (UVFP) is associated with higher morbidity from airway complications due to postoperative laryngeal edema compared with other laryngeal framework surgeries. The aim of this study was to evaluate postoperative laryngeal edema after AA using a new videolaryngoscopic (VL) scoring assessment.Study DesignProspective case series.MethodsNineteen patients with UVFP (14 males and five females; mean age, 56 years) who were treated with AA alone or combined with ansa cervicalis (AA/AC) nerve anastomosis or nerve‐muscle pedicle (AA/NMP) flap implantation were evaluated. Laryngeal edema was assessed by VL scoring for 10 days postoperatively. Degree of edema was scored in three subsites: the membranous vocal fold, arytenoid mound, and pyriform sinus on the operated side. Statistical significance was defined asP< .05.ResultsNo patient experienced postoperative airway compromise. Interexaminer reliability was generally high (Spearmanr> 0.75). The mean degree of edema increased steadily from postoperative day (POD) 1 to 3, peaking on POD 3 at all subsites. It then declined significantly from POD 3 to 7 (P< .05) and gradually through POD 10. The maximum degree of edema, maximum edema time, and operative time were not correlated significantly at any subsite. Maximum edema time and surgery type (AA vs. AA/AC or AA/NMP) were not correlated at any subsite.ConclusionsInter‐rater reliability for the proposed VL scoring was significant at all subsites. The VL findings suggest that AA alone or AA combined with reinnervation showed maximum laryngeal edema on POD 3 but added no significant morbidity.