声带外移固定术治疗新生儿继发性双侧声带麻痹1例并文献复习

A case of secondary bilateral vocal cord paralysis treated by external fixation of vocal cord in a newborn and literature review

摘要

目的 探讨采用支撑喉镜下声带外移固定术治疗气管食管瘘修补术后出现双侧声带麻痹患儿的疗效。方法 患儿行气管食管瘘修补术后出现双侧声带麻痹，伴发严重呼吸困难，考虑医源性损伤可能性大，气管插管状态下保守观察半月后无明显改善，全麻下行支撑喉镜下双侧声带外移固定术，术后给予抗生素预防感染，激素及雾化减轻喉头水肿，抗反流药物抑制食管反流等治疗，气管插管呼吸机支持治疗。结果 术后5 d患儿成功拔除气管插管，呼吸恢复正常并顺利出院，术后8个月复查示双侧声带运动基本恢复并拆除缝线。结论 新生儿双侧声带麻痹可出现严重呼吸困难，采用支撑喉镜下声带外移固定术治疗新生儿双侧声带麻痹是一种安全、有效、微创的手术方式。

Abstract

Objective To investigate the efficacy of bilateral vocal cord external fixation under suspension laryngoscopy for paediatric patients with bilateral vocal cord paralysis following tracheoesophageal fistula repair. Methods A paediatric patient developed bilateral vocal cord paralysis with severe respiratory distress following tracheoesophageal fistula repair, highly suggestive of iatrogenic injury. After two weeks of conservative observation under tracheal intubation with no significant improvement, Under general anaesthesia, bilateral vocal cord external fixation was performed via laryngoscopy. Postoperatively, antibiotics were administered for infection prophylaxis, corticosteroids and nebulisation to reduce laryngeal oedema, and anti-reflux medication to inhibit oesophageal reflux. Tracheal intubation and ventilator support were maintained. Results The infant was successfully extubated on the fifth postoperative day with restored normal respiration and was discharged. An eight-month follow-up revealed near-complete recovery of bilateral vocal cord mobility, and sutures were removed. Conclusion Bilateral vocal cord paralysis in neonates may present with severe respiratory distress. The laryngeal microlaryngoscope-assisted vocal cord fixation technique represents a safe, effective, and minimally invasive surgical approach for managing this condition.

关键词

支撑喉镜 / 声带外移固定术 / 气管食管瘘 / 双侧声带麻痹

Key words

Self-retaining laryngoscope / Vocal cord extroversion / Tracheoesophageal fistula / Bilateral vocal cord paralysis

参考文献

[1] 方杨, 马华安. 儿童双侧声带麻痹诊治的现状与进展[J]. 中国耳鼻咽喉颅底外科杂志, 2024, 30(2): 128-132. DOI: 10.11798/j.issn.1007-1520.202422522

[2] 张丰珍, 王桂香, 赵靖, 等. 新生儿双侧声带麻痹临床特点及预后分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 86-90. DOI: 10.6040/j.issn.1673-3770.0.2021.435

[3] Lee JW, Bon-Mardion N, Smith ME, et al. Bilateral selective laryngeal reinnervation for bilateral vocal fold paralysis in children[J]. JAMA Otolaryngol Head Neck Surg, 2020, 146(5): 401. DOI: 10.1001/jamaoto.2019.4863

[4] 中华耳鼻咽喉头颈外科杂志编辑委员会咽喉组, 中华医学会耳鼻咽喉头颈外科学分会咽喉学组, 中华医学会耳鼻咽喉头颈外科学分会嗓音学组. 声带麻痹诊断及治疗专家共识[J]. 中华耳鼻咽喉头颈外科杂志, 2021, 56(3): 198-209. DOI: 10.3760/cma.j.cn115330-20200924-00765

[5] Hoey AW, Hall A, Butler C, et al. Laryngeal reinnervation for paediatric vocal cord palsy: a systematic review[J]. Eur Arch Otorhinolaryngol, 2022, 279(12): 5771-5781. DOI: 10.1007/s00405-022-07471-y

[6] Kovesi T, Porcaro F, Petreschi F, et al. Vocal cord paralysis appears to be an acquired lesion in children with repaired esophageal atresia/tracheoesophageal fistula[J]. Int J Pediatr Otorhinolaryngol, 2018, 112: 45-47. DOI: 10.1016/j.ijporl.2018.06.031

[7] Koivusalo AI, Suominen JS, Nokso-Koivisto J, Pakarinen MP. Vocal Cord Paralysis after Repair of Esophageal Atresia. Eur J Pediatr Surg. 2024. 34(1): 50-55. DOI: 10.1055/s-0043-1774370

[8] Ortega Beltrá N, Martínez Ruiz de Apodaca P, Matarradona Quiles S, Nieto Curiel P, Dalmau Galofre J. Extralaryngeal causes of unilateral vocal cord paralysis: Aetiology and prognosis. Acta Otorrinolaringol Esp (Engl Ed). 2022. 73(6): 376-383. DOI: 10.1016/j.otoeng.2021.11.002

[9] Jerome R. Lechien. management of pediatric bilateral vocal fold paralysis: a state-of-the-art review of etiologies, diagnosis, and treatments[J]. Children, 2024, 11(4). DOI: 10.3390/children11040398

[10] Daya H, Hosni A, Bejar-Solar I, et al. Pediatric vocal fold paralysis: a long-term retrospective study[J]. Arch Otolaryngol Head Neck Surg, 2000, 126(1): 21. DOI: 10.1001/archotol.126.1.21

[11] 郑宏良, 李孟, 陈世彩. 再论声带麻痹诊治关键问题[J]. 临床耳鼻咽喉头颈外科杂志, 2024, 38(10): 891-896. DOI: 10.13201/j.issn.2096-7993.2024.10.002

[12] 周诗侗, 刘磊, 杨玉成, 等. 喉返神经再支配手术改善单侧声带麻痹嗓音功能的meta分析[J]. 临床耳鼻咽喉头颈外科杂志, 2024, 38(10): 928-934. DOI: 10.13201/j.issn.2096-7993.2024.10.009

[13] 李孟, 郑宏良, 陈世彩, 等. 一侧膈神经上根联合舌下神经甲舌肌支选择性喉返神经修复术治疗双侧声带麻痹的临床分析[J]. 中华耳鼻咽喉头颈外科杂志, 2020, 55(11): 1016-1021. DOI: 10.3760/cma.j.cn115330-20200526-00444

[14] Li M, Zheng HL, Chen SC, et al. Selective reinnervation using phrenic nerve and hypoglossal nerve for bilateral vocal fold paralysis[J]. Laryngoscope, 2019, 129(11): 2669-2673. DOI: 10.1002/lary.27768

[15] 中国医师协会儿科医师分会儿童耳鼻咽喉专业委员会. 儿童声带麻痹诊断和治疗的专家共识[J]. 临床耳鼻咽喉头颈外科杂志, 2023, 37(10): 765-770. DOI: 10.13201/j.issn.2096-7993.2023.10.001

[16] Ejnell H, Tisell LE. Acute temporary laterofixation for treatment of bilateral vocal cord paralyses after surgery for advanced thyroid carcinoma[J]. World J Surg, 1993, 17(2): 277-281. DOI: 10.1007/BF01658947

[17] Madani S, Bach Á, Matievics V, et al. A new solution for neonatal bilateral vocal cord paralysis: Endoscopic arytenoid abduction lateropexy[J]. Laryngoscope, 2017, 127(7): 1608-1614. DOI: 10.1002/lary.26366

[18] Montague GL, Bly RA, Nadaraja GS, et al. Endoscopic percutaneous suture lateralization for neonatal bilateral vocal fold immobility[J]. Int J Pediatr Otorhinolaryngol, 2018, 108: 120-124. DOI: 10.1016/j.ijporl.2018.02.032

[19] Tan LT, Chen C, Li Q. Outcomes of endoscopic percutaneous suture lateralization for neonatal and infantile bilateral vocal ford paralysis[J]. Braz J Otorhinolaryngol, 2023, 89(2): 271-278. DOI: 10.1016/j.bjorl.2022.05.007

[20] Chen YC, Wang X, Teng YS, et al. Long-term Results of Endoscopic Percutaneous Suture Lateralization for Newborns with Bilateral Vocal Cord Paralysis[J]. Laryngoscope, 2025, 135(1): 429-437. DOI: 10.1002/lary.31720

[21] Carneiro NS, Neto J, Salgueiro B, et al. Vocal fold lateralization by percutaneous suture in children: A systematic review. Am J Otolaryngol. 2025. 46(3): 104606. DOI: 10.1016/j.amjoto.2025.104606

[22] Puricelli MD, Peterson J, Kanotra SP. Ultrasound-guided suture lateralization in pediatric bilateral vocal fold immobility[J]. Laryngoscope, 2020, 130(12): E941-E944. DOI: 10.1002/lary.28553