本文選題：聲帶溝　切入點：聲門閉合不全　出處：《蘇州大學(xué)》2016年碩士論文

【摘要】：目的評估顯微喉鏡下經(jīng)甲狀軟骨板自體脂肪聲帶注射術(shù)治療聲帶溝的嗓音療效。方法回顧性分析2008年3月至2014年10月期間收治的病理性聲帶溝患者共36例(男25例、女11例,年齡24-57歲),其中II型聲帶溝21例,III型聲帶溝15例。所有患者都是在全麻顯微喉鏡下行經(jīng)甲狀軟骨板自體脂肪注射聲帶固有層淺層填充術(shù)。所有患者術(shù)前、術(shù)后均接受動態(tài)喉鏡檢查、嗓音主客觀評估(包括GRBAS、Shimmer、Jitter、NNE)以及最長發(fā)音時間(MPT)檢查。術(shù)后6個月和12個月隨訪兩次。結(jié)果無論是II型還是III型聲帶溝患者術(shù)前臨床癥狀主要表現(xiàn)為不同程度的持續(xù)性聲嘶伴發(fā)音疲勞,動態(tài)喉鏡下可見患側(cè)聲帶膜部游離緣縱行溝狀凹陷,粘膜波及振幅減弱,發(fā)音閉合時聲門有裂隙等。II型和III型聲帶溝的兩組患者術(shù)后動態(tài)喉鏡顯示,多數(shù)聲帶仍存在不同程度的溝狀凹陷,但溝狀凹陷明顯變淺,發(fā)音時聲門閉合程度明顯改善,雙側(cè)聲帶振動規(guī)律呈對稱性,黏膜波振幅較術(shù)前明顯增高。II型患者術(shù)后嗓音主客觀各指標(biāo)基本達到正常水平,發(fā)音較術(shù)前均明顯改善,差異有統(tǒng)計學(xué)意義(p0.05)。我們也注意到大多數(shù)的III型聲帶溝患者,盡管術(shù)后發(fā)音時聲門仍存有一定的裂隙,術(shù)后嗓音主客觀各指標(biāo)雖無法完全恢復(fù)到正常水平,但較術(shù)前均明顯改善(p0.05)。隨訪一年,術(shù)后無嚴(yán)重并發(fā)癥發(fā)生。結(jié)論全麻利于患者喉部制動,便于手術(shù)者操作,而顯微喉鏡能更準(zhǔn)確地發(fā)現(xiàn)病側(cè)聲帶的異常結(jié)構(gòu),指導(dǎo)精確定位及操作。我們使用經(jīng)甲狀軟骨板徑路避免了傳統(tǒng)喉內(nèi)徑路的粘膜切開而致聲帶表、體層瘢痕化及注射的脂肪外漏。經(jīng)過術(shù)后動態(tài)喉鏡和嗓音軟件分析,我們認(rèn)為顯微喉鏡下經(jīng)甲狀軟骨板自體脂肪聲帶注射術(shù)治療聲帶溝,可有效改善聲帶溝患者的嗓音質(zhì)量,隨訪1年,II型、III型患者的嗓音質(zhì)量療效穩(wěn)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.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R767.91

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