早期声门型喉癌术后喉形态与嗓音客评估研究

发布时间：2018-01-08 14:15

本文关键词：早期声门型喉癌术后喉形态与嗓音客评估研究　出处：《山东大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：喉癌的发病率位于头颈部恶性肿瘤的第二位,手术是其主要的治疗方式之一。近几十年来,随着对肿瘤研究的深入及手术技巧的提高,喉部分切除术逐渐成为治疗喉癌的主要术式,术中喉的结构重建直接决定着喉术后的形态变化,进一步影响患者术后的嗓音质量。随着早期喉癌治愈率的提高,喉癌患者已不仅满足于肿瘤的治愈,他们对术后嗓音质量的要求也愈加提高,期望进一步改善术后生活质量。目前国内外对喉部分切除术后的评估多局限于生存率、拔管率和患者主观嗓音的评估,缺乏系统的、客观的嗓音和喉形态的研究。本文旨在通过运用客观的嗓音采集与分析,借助CT评估喉声门区形态的改变来客观的研究评价早期声门型喉癌术后患者嗓音和喉形态结构的变化情况,以期建立客观的评估指标,进一步提高喉部分切除术,提高患者的术后嗓音生活质量。方法：(1)研究对象：选取同一年龄段(60-70岁)、病理确诊为鳞状细胞癌Tla或T1b的早期声门型喉癌男性患者33例。33例患者均自愿接受气管切开术和喉部分切除术,术中切除肿瘤后修复喉腔缺损的方式均为室带下拉联合带状肌肌筋膜瓣修复。(2)客观测量：应用德国艾克松EndoSTROB五官科多功能诊断手术系统分别客观检测患者术前1天、术后3个月及1年的嗓音,包括基频(F0)、基频微扰(Jitter)、振幅微扰(Shimmer)、声门噪声能量(NNE)及最长声时(MPT),并用Praat软件对其进行标准化嗓音声学测试；在术前1天与术后1年应用螺旋CT对患者喉部进行扫描,分别测量声门区的前后径,两侧声带突之间距离,及声门区软组织平均厚度。(3)统计学分析：采用SPSS20.0统计分析软件进行。结果：(1)32例患者术后颈部切口Ⅰ期愈合,1例延迟愈合；所有患者在术后1月内全部拔管；31例患者术后随访满1年。(2)手术前后嗓音声学分析,结果显示：手术后3个月的基频、振幅微扰及最长声时比手术前均减小,且差异有统计学意义,t值分别为3.13、2.38及3.91,p值分别为0.04、0.02及0.00；术后1年的振幅微扰、声门噪声能量和最长声时比手术前均减小,且差异有统计学意义,亡值分别为3.65、5.99及2.69,p值分别为0.02、0.00及0.01。(3)手术后不同时期嗓音声学分析比较,结果显示：手术后1年时声门噪声能量比3个月时减小,且差异有显著的统计学意义,亡值为5.11,p值为0.00。(4)手术前后喉形态测量值比较,结果显示：手术后声门区前后径较术前明显减小,且差异有显著的统计学意义,t值为10.46,p值为0.00；手术后声门区软组织平均厚度较术前增大不明显,其差异无统计学意义,其亡值为-1.97,p值为0.058；手术后两侧声带突之间距离较术前减小不明显,其差异无统计学意义,其t值为2.56,p值为0.065。结论：(1)室带下拉联合带状肌肌筋膜瓣可以作为喉成形术中新喉的有效发声振动体；(2)室带下拉联合带状肌肌筋膜瓣修复喉腔缺损,对术后喉形态的影响不大,尤其是对于声门区呼吸部改变较小；(3)早期喉癌患者喉部分切除术后的发声功能均有不同程度的降低；(4)随着术后时间的延长,患者嗓音的稳定程度、声门闭合程度逐渐增大；(5)嗓音多维参数联合喉部CT测量数据可以更为客观、准确的评估患者喉癌术后的喉功能
[Abstract]:Objective: the incidence of cancer in the head and neck malignant tumor second, surgery is one of the main treatment. In recent years, with the skills of tumor research and operation improvement, partial laryngectomy has gradually become the main technique in the treatment of laryngeal carcinoma, reconstruction of laryngeal structure directly determines the form the change of laryngeal surgery, further affect postoperative voice quality. With the improvement of the cure rate of early laryngeal cancer, laryngeal cancer patients have been cured to not only meet the requirements for tumor, postoperative voice quality is more improved, expected to further improve the postoperative quality of life. At home and abroad to the evaluation of partial laryngectomy after the limited to the survival rate, pulling rate and patients subjective voice evaluation tube, the lack of systematic research, the objective form of voice and laryngeal. This paper aims to use voice acquisition and analysis objective, evaluation by CT Objective to evaluate the changes of voice and laryngeal morphology in patients with early glottic laryngocarcinoma after evaluating the morphological changes of glottal area, so as to establish an objective evaluation index, further improve partial laryngectomy and improve voice quality of life.
Methods: (1) research object: select the same age (60-70 years), diagnosed as squamous cell carcinoma Tla or early T1b male patients with glottic carcinoma in 33 cases of.33 patients were voluntarily accepted tracheotomy and partial laryngectomy, laryngeal cavity defect repair after resection of tumor surgery in both chamber drop combined with muscle flap to repair the strip. (2) objective measurement: application of Germany AIKE EndoSTROB loose ent multi-functional diagnostic operation system are objective detection of patients before 1 days, 3 months after operation and the voice of 1 years, including the fundamental frequency (F0), fundamental frequency perturbation (Jitter), amplitude perturbation (Shimmer), normalized noise energy (NNE) and maximum phonation time (MPT), and the standardization of voice acoustic test with Praat software; in the 1 days before and after 1 years of application of spiral CT in patients with laryngeal glottic scan were measured before and after the diameter, the distance between both sides of the vocal process and, The average thickness of soft tissue in glottis area. (3) statistical analysis: SPSS20.0 statistical analysis software was used.
Results: (1) 32 cases of patients with postoperative neck incision healing, delayed healing in 1 cases; all the patients in the postoperative extubation in January; 31 patients were followed up for 1 years. (2) the voice acoustic analysis before and after the operation results show that the fundamental frequency of 3 months after the operation, micro amplitude to disturb the maximum phonation time ratio before operation were reduced, and the difference was statistically significant, t values were 3.13,2.38 and 3.91, P values were 0.04,0.02 and 0; after 1 years the amplitude of the perturbation, normalized noise energy and maximum sound than before operation were reduced, and the difference was statistically significant, dead the values were 3.65,5.99 and 2.69, P = 0.02,0.00 and 0.01. (3) in different periods after the operation of voice acoustic analysis, results showed that: 1 years after the operation when the normalized noise energy more than 3 months time reduced, and the difference was statistically significant, the death was 5.11, P value is 0.00. (4) hand shape measurements than before and after operation of larynx The results show that before and after surgery, after the glottic diameter decreased, and the difference was statistically significant, t = 10.46, P = 0; postoperative soft tissue glottic average thickness increased compared with pre operation is not obvious, the difference was not statistically significant, the dead value is -1.97, P value 0.058; after operation between the two sides of the vocal process distance was decreased significantly, the difference was not statistically significant, the T value is 2.56, P value is 0.065.
Conclusion: (1) combined with the drop-down room banded muscle flap can be used as a new effective throat throat forming sound vibration during operation; (2) with ventricular muscle flap combined with drop repair laryngeal defect, has little effect on the morphology of larynx after surgery, especially for glottic respiratory, little change; (3) reduce the early laryngeal cancer patients after resection of laryngeal vocal function in varying degrees; (4) with the extension of time after surgery, the degree of stability of the vocal tract, glottal closure degree gradually increased; (5) with laryngeal CT measurement data can be more objective voice of multidimensional parameters, evaluation of laryngeal carcinoma patients the laryngeal function accurately

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.65

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