Результаты хирургического лечения с использованием СО2-лазера у больных с двусторонним параличом гортани

Abstract

Introduction. Despite advances in modern surgery, the percentage of patients with bilateral paralysis of the larynx is not decreasing. There are many author’s methods of treatment, but there is no single algorithm. This problem remains relevant, especially among people of working age. Research objective: Optimization of surgical treatment of patients with bilateral paralysis of the larynx using a CO2-laser. Materials and methods. For 2014–2018, 143 patients diagnosed with bilateral paralysis of the larynx were treated. The patients underwent a general clinical examination, video endolaryngoscopy, video stroboscopy, spirometry, acoustic voice analysis. For a subjective assessment of the condition, patients filled out the VOICE HANDICAP INDEX (VHI) voice questionnaire, the 36-Item Short Form Survey (SF-36) quality of life questionnaire. Depending on the degree of stenosis, age, body mass index, the presence of a tracheostomy, comorbidities, the following operations were performed using a CO2-laser: posterior partial chordotomy, posterior vestibulo-chordotomy, posterior chordotomy with wound defect plasty. Results and discussion: The patients followed up for 6 to 12 months in the postoperative period. A positive outcome achieved in 128 patients (90%). 15 patients needed a second operation. Tracheostomy patients were decannulated on days 3 to 5. Conclusion. Restoration of respiratory function was achieved by expanding the lumen of the glottis in the posterior parts of the larynx, while maintaining a socially adapted voice was achieved due to intact anterior two-thirds of the vocal folds. These methods are among the most effective and minimally invasive methods for the treatment of bilateral paralysis of the larynx.