本文關(guān)鍵詞：早期聲門型喉癌術(shù)后喉形態(tài)與嗓音客評估研究　出處：《山東大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 喉部分切除術(shù) 聲學(xué)分析 聲門 CT 形態(tài)

【摘要】：目的：喉癌的發(fā)病率位于頭頸部惡性腫瘤的第二位,手術(shù)是其主要的治療方式之一。近幾十年來,隨著對腫瘤研究的深入及手術(shù)技巧的提高,喉部分切除術(shù)逐漸成為治療喉癌的主要術(shù)式,術(shù)中喉的結(jié)構(gòu)重建直接決定著喉術(shù)后的形態(tài)變化,進(jìn)一步影響患者術(shù)后的嗓音質(zhì)量。隨著早期喉癌治愈率的提高,喉癌患者已不僅滿足于腫瘤的治愈,他們對術(shù)后嗓音質(zhì)量的要求也愈加提高,期望進(jìn)一步改善術(shù)后生活質(zhì)量。目前國內(nèi)外對喉部分切除術(shù)后的評估多局限于生存率、拔管率和患者主觀嗓音的評估,缺乏系統(tǒng)的、客觀的嗓音和喉形態(tài)的研究。本文旨在通過運(yùn)用客觀的嗓音采集與分析,借助CT評估喉聲門區(qū)形態(tài)的改變來客觀的研究評價(jià)早期聲門型喉癌術(shù)后患者嗓音和喉形態(tài)結(jié)構(gòu)的變化情況,以期建立客觀的評估指標(biāo),進(jìn)一步提高喉部分切除術(shù),提高患者的術(shù)后嗓音生活質(zhì)量。 方法：(1)研究對象：選取同一年齡段(60-70歲)、病理確診為鱗狀細(xì)胞癌Tla或T1b的早期聲門型喉癌男性患者33例。33例患者均自愿接受氣管切開術(shù)和喉部分切除術(shù),術(shù)中切除腫瘤后修復(fù)喉腔缺損的方式均為室?guī)吕?lián)合帶狀肌肌筋膜瓣修復(fù)。(2)客觀測量：應(yīng)用德國艾克松EndoSTROB五官科多功能診斷手術(shù)系統(tǒng)分別客觀檢測患者術(shù)前1天、術(shù)后3個(gè)月及1年的嗓音,包括基頻(F0)、基頻微擾(Jitter)、振幅微擾(Shimmer)、聲門噪聲能量(NNE)及最長聲時(shí)(MPT),并用Praat軟件對其進(jìn)行標(biāo)準(zhǔn)化嗓音聲學(xué)測試；在術(shù)前1天與術(shù)后1年應(yīng)用螺旋CT對患者喉部進(jìn)行掃描,分別測量聲門區(qū)的前后徑,兩側(cè)聲帶突之間距離,及聲門區(qū)軟組織平均厚度。(3)統(tǒng)計(jì)學(xué)分析：采用SPSS20.0統(tǒng)計(jì)分析軟件進(jìn)行。 結(jié)果：(1)32例患者術(shù)后頸部切口Ⅰ期愈合,1例延遲愈合；所有患者在術(shù)后1月內(nèi)全部拔管；31例患者術(shù)后隨訪滿1年。(2)手術(shù)前后嗓音聲學(xué)分析,結(jié)果顯示：手術(shù)后3個(gè)月的基頻、振幅微擾及最長聲時(shí)比手術(shù)前均減小,且差異有統(tǒng)計(jì)學(xué)意義,t值分別為3.13、2.38及3.91,p值分別為0.04、0.02及0.00；術(shù)后1年的振幅微擾、聲門噪聲能量和最長聲時(shí)比手術(shù)前均減小,且差異有統(tǒng)計(jì)學(xué)意義,亡值分別為3.65、5.99及2.69,p值分別為0.02、0.00及0.01。(3)手術(shù)后不同時(shí)期嗓音聲學(xué)分析比較,結(jié)果顯示：手術(shù)后1年時(shí)聲門噪聲能量比3個(gè)月時(shí)減小,且差異有顯著的統(tǒng)計(jì)學(xué)意義,亡值為5.11,p值為0.00。(4)手術(shù)前后喉形態(tài)測量值比較,結(jié)果顯示：手術(shù)后聲門區(qū)前后徑較術(shù)前明顯減小,且差異有顯著的統(tǒng)計(jì)學(xué)意義,t值為10.46,p值為0.00；手術(shù)后聲門區(qū)軟組織平均厚度較術(shù)前增大不明顯,其差異無統(tǒng)計(jì)學(xué)意義,其亡值為-1.97,p值為0.058；手術(shù)后兩側(cè)聲帶突之間距離較術(shù)前減小不明顯,其差異無統(tǒng)計(jì)學(xué)意義,其t值為2.56,p值為0.065。 結(jié)論：(1)室?guī)吕?lián)合帶狀肌肌筋膜瓣可以作為喉成形術(shù)中新喉的有效發(fā)聲振動體；(2)室?guī)吕?lián)合帶狀肌肌筋膜瓣修復(fù)喉腔缺損,對術(shù)后喉形態(tài)的影響不大,尤其是對于聲門區(qū)呼吸部改變較��；(3)早期喉癌患者喉部分切除術(shù)后的發(fā)聲功能均有不同程度的降低；(4)隨著術(shù)后時(shí)間的延長,患者嗓音的穩(wěn)定程度、聲門閉合程度逐漸增大；(5)嗓音多維參數(shù)聯(lián)合喉部CT測量數(shù)據(jù)可以更為客觀、準(zhǔn)確的評估患者喉癌術(shù)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

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R739.65

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