显微喉镜下经甲状软骨板自体脂肪声带注射术治疗声带沟的嗓音疗效分析

发布时间：2018-04-03 16:36

本文选题：声带沟　切入点：声门闭合不全　出处：《苏州大学》2016年硕士论文

【摘要】：目的评估显微喉镜下经甲状软骨板自体脂肪声带注射术治疗声带沟的嗓音疗效。方法回顾性分析2008年3月至2014年10月期间收治的病理性声带沟患者共36例(男25例、女11例,年龄24-57岁),其中II型声带沟21例,III型声带沟15例。所有患者都是在全麻显微喉镜下行经甲状软骨板自体脂肪注射声带固有层浅层填充术。所有患者术前、术后均接受动态喉镜检查、嗓音主客观评估(包括GRBAS、Shimmer、Jitter、NNE)以及最长发音时间(MPT)检查。术后6个月和12个月随访两次。结果无论是II型还是III型声带沟患者术前临床症状主要表现为不同程度的持续性声嘶伴发音疲劳,动态喉镜下可见患侧声带膜部游离缘纵行沟状凹陷,粘膜波及振幅减弱,发音闭合时声门有裂隙等。II型和III型声带沟的两组患者术后动态喉镜显示,多数声带仍存在不同程度的沟状凹陷,但沟状凹陷明显变浅,发音时声门闭合程度明显改善,双侧声带振动规律呈对称性,黏膜波振幅较术前明显增高。II型患者术后嗓音主客观各指标基本达到正常水平,发音较术前均明显改善,差异有统计学意义(p0.05)。我们也注意到大多数的III型声带沟患者,尽管术后发音时声门仍存有一定的裂隙,术后嗓音主客观各指标虽无法完全恢复到正常水平,但较术前均明显改善(p0.05)。随访一年,术后无严重并发症发生。结论全麻利于患者喉部制动,便于手术者操作,而显微喉镜能更准确地发现病侧声带的异常结构,指导精确定位及操作。我们使用经甲状软骨板径路避免了传统喉内径路的粘膜切开而致声带表、体层瘢痕化及注射的脂肪外漏。经过术后动态喉镜和嗓音软件分析,我们认为显微喉镜下经甲状软骨板自体脂肪声带注射术治疗声带沟,可有效改善声带沟患者的嗓音质量,随访1年,II型、III型患者的嗓音质量疗效稳定。
[Abstract]:Objective to evaluate the effect of autologous fat vocal cord injection under microlaryngoscope in the treatment of vocal cord sulcus.Methods from March 2008 to October 2014, a total of 36 patients (25 males and 11 females, aged 24-57 years) with pathological vocal cord sulcus, including 21 patients with type II vocal cord sulcus and 15 patients with type III vocal cord sulcus, were retrospectively analyzed.All patients were treated with transthyroid chondroid autologous fat injection of vocal cord superficial lamina under general anesthesia microlaryngoscope.All patients were examined with dynamic laryngoscope, subjective and objective voice assessment (including GRBAS-ShimmerJitternne) and MPT before and after operation.They were followed up twice 6 and 12 months after operation.Results the clinical symptoms of patients with type II or type III vocal cord sulcus before operation were mainly persistent hoarseness with articulation fatigue. Under dynamic laryngoscope, the free edge of the vocal cord membrane of the affected side could be seen in longitudinal trench depression, and the amplitude of mucosal ripple was decreased.Dynamic laryngoscopy showed that most of the vocal cords still had different degrees of groove depression, but the groove depression was obviously shallower, and the glottis closure was improved obviously when the vocal closure was pronounced in the two groups, such as the fissure of the glottis and the III type of vocal cord sulcus, and the dynamic laryngoscopy showed that most of the vocal cords still had different degrees of trench.The vibration regularity of bilateral vocal cords was symmetrical, the amplitude of mucosal wave was significantly higher than that of pre-operation. The subjective and objective indexes of voice of patients with type II basically reached the normal level after operation, and the pronunciation was improved obviously compared with those before operation, and the difference was statistically significant (P 0.05).We also noticed that in most patients with III type vocal cord sulcus, although there were still some cracks in the glottis after operation, the subjective and objective indexes of postoperative voice could not completely return to normal level, but they were significantly improved compared with those before operation.There were no serious complications after one year follow-up.Conclusion General anesthesia is beneficial to laryngeal immobilization and easy to operate. Microlaryngoscope can more accurately detect abnormal structure of vocal cord and guide accurate location and operation.We use the thyroid cartilage plate approach to avoid incision of the mucous membrane of the traditional laryngeal approach, resulting in vocal cord surface, body scarring, and injected fat leakage.After dynamic laryngoscope and voice software analysis, we believe that microlaryngoscope with autologous fat vocal cord injection through thyroid cartilage plate can effectively improve the voice quality of patients with vocal cord sulcus.All patients were followed up for 1 year. The effect of voice quality was stable in patients with type II or type III.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R767.91

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