Vocal Cord Paralysis after Repair of Esophageal Atresia.

IF 1.5 3区 医学 Q2 PEDIATRICS European Journal of Pediatric Surgery Pub Date : 2024-02-01 Epub Date: 2023-09-05 DOI:10.1055/s-0043-1774370
A I Koivusalo, J S Suominen, J Nokso-Koivisto, M P Pakarinen
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Abstract

Objective:  Etiology of vocal cord paralysis (VCP) and laryngeal dysfunction may be congenital or surgical trauma of recurrent and superior laryngeal nerves. We assessed the incidence, risk factors, and morbidity of VCP after repair of esophageal atresia (EA).

Methods:  Medical records of 201 EA patients from 2000 to 2022 were reviewed for this retrospective study. Postrepair vocal cord examination (VCE) included awake nasolaryngeal fiberoscopy by otolaryngologist or laryngoscopy under spontaneous breathing anesthesia. Before 2017, postoperative VCE was performed in symptomatic patients only and routinely after 2017.

Main results:  Overall, VCE was performed on 79 (38%) patients (52 asymptomatic), whereas 122 asymptomatic patients underwent no VCE. VCP was diagnosed in 32 of 79 patients (right 12, left 10, and bilateral 10; symptomatic 25 and asymptomatic unilateral 7) corresponding with extrapolated overall VCP incidence of 16 to 24% among 201 patients including asymptomatic ones. Ten patients (bilateral VCP 8 and left VCP 2) required tracheostomy. Of 10 patients with bilateral VCP, three underwent laryngotracheal expansion surgery (left VC lateralization in one and laryngoplasty in two with acquired subglottic stenosis), three remained tracheostomy dependent, three were off tracheostomy, and one died of complications after redo esophageal reconstruction. All patients with unilateral VCP managed without tracheostomy. Cervical dissection or ostomy formation was a major risk factor of VCP.

Conclusion:  Repair of EA is associated with a considerable risk of VCP and associated morbidity. Cervical EA surgery significantly increased the risk of VCP. Bilateral VCP may eventually require laryngotracheal expansion surgery.

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食道闭锁修复术后的声带麻痹。
目的:声带麻痹(VCP)和喉功能障碍的病因可能是先天性的,也可能是喉返神经和喉上神经的手术创伤。我们评估了食道闭锁(EA)修复术后声带麻痹的发生率、风险因素和发病率:这项回顾性研究回顾了 2000 年至 2022 年期间 201 名食道闭锁患者的病历。修复后声带检查(VCE)包括由耳鼻喉科医生进行的清醒鼻咽纤维镜检查或在自主呼吸麻醉下进行的喉镜检查。2017 年之前,术后 VCE 仅在有症状的患者中进行,2017 年之后则常规进行:总体而言,79 名(38%)患者(52 名无症状)进行了 VCE,而 122 名无症状患者未进行 VCE。79 名患者中有 32 人(右侧 12 人、左侧 10 人、双侧 10 人;有症状 25 人、无症状单侧 7 人)确诊为 VCP,推断 201 名患者(包括无症状患者)中 VCP 的总发病率为 16% 至 24%。10 名患者(双侧 VCP 8 例,左侧 VCP 2 例)需要进行气管造口术。在 10 名双侧 VCP 患者中,3 人接受了喉气管扩张手术(1 人接受了左侧 VC 侧切术,2 人接受了喉成形术,并伴有后天性声门下狭窄),3 人仍然依赖气管造口术,3 人脱离了气管造口术,1 人在重新进行食管重建后死于并发症。所有单侧 VCP 患者均无需气管造口术。颈椎解剖或造口形成是 VCP 的主要风险因素:结论:EA修复术与VCP的高风险和相关发病率有关。宫颈 EA 手术大大增加了 VCP 的风险。双侧 VCP 最终可能需要进行喉气管扩张手术。
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来源期刊
CiteScore
3.90
自引率
5.60%
发文量
66
审稿时长
6-12 weeks
期刊介绍: This broad-based international journal updates you on vital developments in pediatric surgery through original articles, abstracts of the literature, and meeting announcements. You will find state-of-the-art information on: abdominal and thoracic surgery neurosurgery urology gynecology oncology orthopaedics traumatology anesthesiology child pathology embryology morphology Written by surgeons, physicians, anesthesiologists, radiologists, and others involved in the surgical care of neonates, infants, and children, the EJPS is an indispensable resource for all specialists.
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