背景:双侧声带不活动(BVFI)可继发声门阻塞。治疗选择包括气管造口术以绕过阻塞部位以及单侧横向心脏切开术以减轻阻塞。这篇综述的目的是确定疗效,不良事件概况,和长期结果,包括气管造口术的需要,在接受单侧脊髓切开术的患者中。
方法:本系统评价遵循系统评价和荟萃分析(PRISMA)指南的首选报告系统。通过检索PubMed,科克伦图书馆,和Embase。纳入了介绍单侧脊髓切开术治疗BVFI病例的文章。评论文章,动物研究,非英语文章,和摘要被排除在外。排除了双侧髓核切开术或髓核切开术的病例。
结果:我们确定了14项研究和291例接受单侧脊髓切开术的患者。68例患者在进行心脏切开术时进行了气管切开术。术后最常见的并发症是肉芽组织形成(n=39)。31例患者出现声门水肿并随后出现呼吸困难。三名患者恢复到阻塞的气道,在主要的心脏切开术部位形成了疤痕。由于这些并发症,有9例患者需要进行心脏切开术后气管切开术。五名患者需要长期气管切开术,无法拔管。
结论:单侧声带切开术是治疗声门梗阻的有效方法,术后拔管率高。包括声门阻塞恶化在内的不良事件并不常见,尽管水肿和肉芽组织可能在术后发展,需要密切的术后监测。喉镜,133:6-14,2023年。
Glottic obstruction may arise secondary to bilateral vocal fold immobility (BVFI). Treatment options include a tracheostomy to bypass the site of obstruction as well as unilateral transverse cordotomy to alleviate the obstruction. The objective of this review is to determine the efficacy, adverse event profile, and long-term outcomes, including the need for tracheostomy, in patients undergoing unilateral cordotomy.
The Preferred Reporting Systems for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed for this systematic review. A literature search of unilateral cordotomy was performed by searching PubMed, Cochrane Library, and Embase. Articles presenting cases of BVFI treated with unilateral cordotomy were included. Review articles, animal studies, non-English-language articles, and abstracts were excluded. Articles presenting cases of bilateral cordotomy or cordotomy with arytenoidectomy were excluded.
We identified 14 studies and 291 patients undergoing unilateral cordotomy. Sixty-eight patients had a prior tracheostomy in place at the time of cordotomy. The most common post-operative complication was granulation tissue formation (n = 39). Thirty-one patients developed glottic edema with subsequent dyspnea. Three patients developed scarring of the primary cordotomy site with the return to an obstructed airway. Nine patients required a post-cordotomy tracheostomy due to these complications. Five patients required a long-term tracheostomy and were unable to be decannulated.
Unilateral cordotomy is an effective treatment for glottic obstruction with high post-operative decannulation rates. Adverse events including worsening glottic obstruction are uncommon, although edema and granulation tissue may develop in the post-operative period and necessitate close post-operative monitoring. Laryngoscope, 133:6-14, 2023.