- 期刊
以Gelfoam® Paste注射作為單側聲帶麻痺的暫時性復健方式
Gelfoam® Paste Injection for the Temporary Rehabilitation of Unilateral Vocal Cord Paralysis
摘要
目的：利用喉內注射的方法來處理病人單側聲帶麻痺的問題，早在20世紀初期就被發展出來，而Teflon一度是最廣泛被使用的材質。由於Teflon在人體內不易被吸收，因此對於急性單側聲帶麻痺的病患，一則不確定聲帶功能是否恢復，再則健側聲帶可能完成代償性移位，並不宜貿然實施Teflon注射，或甲狀軟骨成形術等永久性喉部複健方式。因此，若能使用可吸收的物質做喉內注射，不但可以在急性期內改善病人嘶啞、嗆食等症狀，並且可以觀察病患聲帶功能復原的情形。本研究之目的在以可吸收的Gelfoam® Paste實施聲帶注射，作為單側聲帶麻痺的暫時性複健方式，並就其結果加以分析討論。 方法：自1999年12月至2000年7月間，計有8名病人因單側聲帶麻痺造成聲門閉鎖不全而接受Gelfam® Paste喉內注射。由於本院並無現在Gelfoam® Paste可供使用，必須自行製備。我們以Gelfoam® Sponge加上生理食鹽水混合後，研磨至呈膏狀供注射用。進行手術的方式與常見的Teflon喉內注射相似。術後追蹤時間為2至7個月。 結果：八名病人中，男性4名，女性4名，平均年齡51歲。惡性腫瘤者3例，頸部外傷者2例，中風者1例，不明原因者2例。所有患者均能順利完成手術。術後嘎款、嗆食、說話費力等現象都能獲得相當程度的改善。追蹤顯示，Gelfoam® Paste注射的效果約可持續12到16周。有2名病患在術後6至8周，單側聲帶麻痺的情形消失，喉部功能完全恢復。所有病患追蹤至今，除一例在患側聲帶突產生一肉芽腫之外，無任何併發症。 結論：Gelfoam 很早在外科領域中被用來當作止血的材料，在人體中可被完全的吸收。使用Gelfoam® Paste進行喉內注射並不會對喉頭組織造成重大的不良影響。因此對於急性單側聲帶麻痺，無法預期其聲帶功能是否能恢復的病患，以Gelfoam® Paste注射來施行暫時性的聲帶複健，應是極佳的選擇。由於項術式兼具經濟與方便的特性，若能配合注射方法的改進，相信可以讓更多病人受益。
並列摘要
BACKGROUND: Unilateral vocal cord paralysis is usually treated by intracordal fat injection, thyroplasty or reinnervation. However, all these procedures are not suitable for patients with acute unilateral vocal fold paralysis, particularly if spontaneous recovery still seems possible. While awaiting for possible regain of cord function, urgent temporary vocal rehabilitation maneuver is needed to cope with symptoms like hoarseness and choking, caused by acute vocal dysfunction. METHODS: Between December 1999 and July 2000, intracordal Gelfoam® Paste injection was used as a maneuver for temporary rehabilitation of 8 patients having acute unilateral vocal dysfunction. The Gelfoam® Paste was first prepared by the addition of saline and then ground into paste form for injection, adopting a procedure similar to traditional intracordal Teflon injection with a Brunings syringe. The injection was performed either transorally under general anesthesia or via a transcutaneous route under local anesthesia. All patients tolerated the procedure well and were discharged the next day after the operation. Oral antibiotics were prescribed to prevent infection. RESULTS: The hoarseness, choking and strained speech symptoms improved significantly in most patients after the operation. Two patients had spontaneous recovery of their vocal function in 6 and 8 weeks. No serious complication was noted except that a small granuloma appeared on the injected cord in one of the two patients. The granuloma resolved spontaneously during follow-up visiting. The effect of Gelfoam® Paste injection were noted to last between 12 and 16 weeks for the remaining six patients. CONCLUSIONS: The present study demonstrated that intracordal Gelfoam® Paste injection can successfully relieve the symptoms caused by acute unilateral vocal paralysis. The operation is simple, cost-effective and familiar to most ENT physicians. As the Gelfoam® Paste can be completely absorbed by human tissues and causes little tissue reactions, the operation is also safe. Therefore, intracordal Gelfoam® Paste injection can be considered as a good option for the temporary rehabilitation of impaired cord function.