中国耳鼻咽喉头颈外科12007年4月，第14卷，第4期构状软骨内移联合喉返神经修复术治疗单侧声带麻痹陈世彩，郑宏良，周水森，李兆基，陈刚，张贤，荆建军，陈东辉，施剑斌(第二军医大学长海医院耳鼻咽喉科，上海200433)【摘要】目的探讨构状软骨内移联合颈拌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3一22年外伤性喉返神经损伤单侧声带麻痹患者12例，行患侧构状软骨内移的同时，作颈拌喉返神经吻合术。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。结果所有患者构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(尸值均<0.05);喉镜检查见构状软骨明显内移，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沪值均<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。结论构状软骨内移联合颈拌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。哄键词]声带麻痹;神经再生;构状软骨;外科手术APrimarystudyofarytenoidwithin一shifcombiningwithrecurrentlaryngeaInervetransPositionCHENShicai，2月ENGHongliang，ZHOUShuimiao，LIZhaoji，CHENGang，ZHANGXian，JINGJ泊njun，CHENDonghui，SHIJianbin(DePartmentofotolaryngology，ChanghaiHosPital，SecondMIlitaryMedicalUniversity，Shanghai，200433，China)CorresPondingauthor:ZHENGHongliang(Email:zhenghl@smmu.edu.cn)[ABSTRACT]OBJECTIVETostudythetheraPeutice能ctofary’tenoidwithin一shiftcombiningwithrecurrentlaryngealnerve(RLN)anastomosistoansacervicalisforPatientswithlong一termunilateralvocalcordParalysis(UVCP).METHODSTwelvePatientswjthtraumaticRLNsParaiysiswerestudied.Thecoursesofiniuryvariedfrom3to22years.RLNwasanastomosedtoansacervicalisandarytenoidwaswithin一shi什edoniPsilateralsideinallPatjents.TheraPeuticeficacywasevaluatedbylaryngoscoPe，strobe一IaryngoscoPe，vojceevaluation，voiceacousticsParameteranalysis，andIaryngealelectromyograPhy(LEMG).RESULTSThevoicewasimProvedinallcasesafterarytenoidwithin-shifimmediateIy.ThemeanvaIuesofvoiceacousticsParameterSOitter，shimmer，NNE)weresignificantlysmallerandmaximumPhonationtime(MPT)weresignificantIyIongerafteroPerationcomParedwiththoseofbeforetreatment.LaryngoscoPeshowedthatarytenoidwassignificantlywithin一shifted.TheglotticPosteriorchinkvanishedin9casesandreducedin3cases.Thevoiceresumednormal，obviouslyimProved，imProvedandnoimProvedwerefoundin9、3、0‘0casesresPectively12monthsafteroPeration.ThemassandtensionofalltreatedvocalcordsmaybeC0metheS8m68StheCOntrslsteFS!nOFmalVOCalcords，thusresumingsymmetricvibrationofthevocalcords.ThereinnervationoftheRLNswereaPProvedbyLEMGinthesePatientswhoseRLNswererestored.CONCLUS10NArytenoidwithin一shiftcombiningwithRLNan8Stom0SISt08nsaCe四iCalC8nresto陀dnormslvoiceinPatientswithlong一termUVC只[Keywords]VocalCordParalysis;NerveRegeneration;ArytenoidCartilage;SurgicalProcedures，OPerative第一作者简介及通讯:陈世彩，女，湖北人，医学博士，副主任医师，主要专业方向为喉外科。Email:docchen5775@yahoo.com.cn通讯作者:郑宏良(Email:zhenghl@smmu.edu.cn)cHlNARcH0TOLARYNGOLHEAoNEcKsURGIAPril2007，VO1.14，No.4223中国耳鼻咽喉头颈外科/2007年4月，第14卷，第4期喉返神经损伤声带麻痹为喉科较常见外伤性疾病。作者对肌电图检查判断无望恢复喉功能的喉返神经损伤患者尽早进行神经探查1]，对被缝线结扎或瘸痕粘连压...
