本文選題：聲帶麻痹 + 頸袢神經(jīng)��； 參考：《第二軍醫(yī)大學(xué)》2011年博士論文

【摘要】：單側(cè)聲帶麻痹是耳鼻咽喉科較常見疾病,其病因有醫(yī)源性、腫瘤源性、特發(fā)性和外傷性等�；颊咄憩F(xiàn)為聲音嘶啞,飲水嗆咳等臨床癥狀,這些癥狀嚴(yán)重影響了患者的生活質(zhì)量。臨床上治療單側(cè)聲帶麻痹的手術(shù),主要有聲帶注射術(shù)、甲狀軟骨成形術(shù)杓狀軟骨內(nèi)收術(shù)、喉神經(jīng)修復(fù)術(shù)等。其中聲帶注射術(shù)、甲狀軟骨成形術(shù)和杓狀軟骨內(nèi)收術(shù)均能有效的改善聲嘶癥狀,但由于沒有恢復(fù)喉肌的神經(jīng)再支配,嗓音的遠(yuǎn)期療效尚不滿意。隨著顯微外科技術(shù)的發(fā)展,聲帶麻痹神經(jīng)修復(fù)的治療已取得了很大的進(jìn)步。頸袢喉返神經(jīng)修復(fù)術(shù)是國際上最為常用的喉神經(jīng)修復(fù)術(shù)之一。但目前文獻(xiàn)報(bào)道該種手術(shù)的病例數(shù)量相對(duì)較少,且缺乏針對(duì)遠(yuǎn)期療效的研究。不同失神經(jīng)病程對(duì)于手術(shù)療效的影響尚未見文獻(xiàn)報(bào)道。至今文獻(xiàn)中尚缺乏確鑿的證據(jù)證明對(duì)側(cè)頸袢喉返神經(jīng)修復(fù)術(shù)的療效。本課題目的有以下幾點(diǎn):1、研究頸袢主支喉返神經(jīng)修復(fù)術(shù)和頸袢分支喉返神經(jīng)修復(fù)術(shù)的遠(yuǎn)期療效;2、比較頸袢主支喉返神經(jīng)修復(fù)術(shù)與頸袢分支喉返神經(jīng)修復(fù)術(shù)的療效差異;3、研究不同失神經(jīng)病程對(duì)于頸袢喉返神經(jīng)修復(fù)術(shù)療效的影響;4、評(píng)估對(duì)側(cè)頸袢喉返神經(jīng)修復(fù)術(shù)治療單側(cè)聲帶麻痹的療效。為了正確且全面的評(píng)估手術(shù)療效,需要使用不同評(píng)價(jià)方法多維度全面系統(tǒng)地評(píng)估治療效果。然而目前國內(nèi)嗓音醫(yī)學(xué)剛剛起步,尚缺乏嗓音聽感知評(píng)估的標(biāo)準(zhǔn)方法。動(dòng)態(tài)喉鏡是觀察喉部結(jié)構(gòu)和功能狀態(tài)不可或缺的檢查方法,至今文獻(xiàn)中尚缺乏針對(duì)單側(cè)聲帶麻痹的可靠且有效的主觀評(píng)估方法,所以本研究嘗試建立國內(nèi)嗓音RBH主觀聽感知評(píng)估系統(tǒng)的漢語普通話版,驗(yàn)證其可信度和效度。同時(shí)建立可靠且有效的單側(cè)聲帶麻痹動(dòng)態(tài)喉鏡主觀視感知評(píng)估表,全面系統(tǒng)評(píng)價(jià)喉返神經(jīng)修復(fù)治療效果。故本研究共分為四個(gè)部分: 第一部分建立國內(nèi)嗓音RBH主觀聽感知評(píng)估系統(tǒng)的漢語普通話版。 目的:嘗試建立國內(nèi)嗓音RBH主觀聽感知評(píng)估系統(tǒng)的漢語普通話版。方法:首先設(shè)計(jì)一篇普通話朗讀文本,從聲母、韻母、聲調(diào)三者構(gòu)成比與中科院聲學(xué)研究所提出的漢語相應(yīng)音素構(gòu)成比做相似性檢驗(yàn),并對(duì)該文本進(jìn)行易讀性檢驗(yàn)。收集正常嗓音40例和病理性嗓音160例的持續(xù)長元音和朗讀聲樣本,同步測(cè)量長元音基頻微擾、振幅微擾、噪諧比、最長聲時(shí)、平均氣流率、嗓音障礙指數(shù)。請(qǐng)3位專家初步制定RBH主觀聽感知評(píng)估系統(tǒng)漢語普通話版。然后讓7位聽評(píng)委依據(jù)初訂的RBH主觀聽感知評(píng)估系統(tǒng)對(duì)160例嗓音樣本進(jìn)行評(píng)估,評(píng)委間一致性檢驗(yàn)采用組內(nèi)相關(guān)系數(shù),而評(píng)委自身穩(wěn)定性檢驗(yàn)采用Kappa系數(shù),并檢驗(yàn)其效度。結(jié)果:設(shè)計(jì)的標(biāo)準(zhǔn)普通話朗讀文本的聲母、韻母、聲調(diào)三者構(gòu)成比與漢語相應(yīng)構(gòu)成比高度相似性,易讀性良好。RBH三指標(biāo)粗糙聲、氣息聲、嘶啞聲的評(píng)委間一致性分別為0.86、0.81、0.89。聽評(píng)委的自身一致性在0.45-0.72之間。在嘶啞聲的四個(gè)等級(jí)中組,基頻微擾、振幅微擾、噪諧比、最長聲時(shí)、平均氣流率、嗓音障礙指數(shù)在每相鄰兩個(gè)等級(jí)之間比較均有統(tǒng)計(jì)學(xué)意義(p均0.05)。在粗糙聲的四個(gè)等級(jí)中組,基頻微擾、振幅微擾、噪諧比在每相鄰兩個(gè)等級(jí)之間比較均有統(tǒng)計(jì)學(xué)差異(p均0.05)。在氣息聲的四個(gè)等級(jí)中組,噪諧比、最長聲時(shí)、平均氣流率在每相鄰等級(jí)之間比較均有統(tǒng)計(jì)學(xué)差異。(p均0.05)。 結(jié)論:設(shè)計(jì)的標(biāo)準(zhǔn)化朗讀短文《害人終害己》的音素構(gòu)成比與中科院漢語相應(yīng)音素構(gòu)成比高度相似且易讀性良好。嗓音RBH聽感知評(píng)估系統(tǒng)漢語普通話版的信度和效度良好。 第二部分單側(cè)聲帶麻痹的動(dòng)態(tài)喉鏡主觀知評(píng)分表的建立。目的:建立單側(cè)聲帶麻痹的動(dòng)態(tài)喉鏡視感知評(píng)分表,為量化評(píng)估聲帶麻痹奠定基礎(chǔ)。方法:根據(jù)文獻(xiàn)并結(jié)合聲帶麻痹特點(diǎn),選擇聲帶振幅、聲門上運(yùn)動(dòng)、患側(cè)聲帶位置、聲門閉合程度、閉合商、聲帶振動(dòng)的對(duì)稱性和規(guī)律性組成初步評(píng)估表,以11名評(píng)委對(duì)不同聲嘶程度的單側(cè)聲帶麻痹患者48例進(jìn)行評(píng)估,用組內(nèi)相關(guān)系數(shù)統(tǒng)計(jì)評(píng)委間一致性,Kappa系數(shù)分析評(píng)委自身穩(wěn)定性。用手術(shù)療效明確的單側(cè)聲帶麻痹患者76例作為檢驗(yàn)評(píng)分表效度的工具,檢驗(yàn)評(píng)估表的各項(xiàng)指標(biāo)在手術(shù)前后有無差異。結(jié)果:選擇自身穩(wěn)定性高的評(píng)委有利于提高評(píng)委間一致性,以5名自身穩(wěn)定性最高評(píng)委的評(píng)估結(jié)果,觀察指標(biāo)中有6個(gè)指標(biāo)較為滿意,患側(cè)聲帶位置、聲門閉合程度、閉合商、患側(cè)聲帶邊緣直線、聲帶振動(dòng)的對(duì)稱性和規(guī)律性的評(píng)委一致性在0.55-0.80之間。聲帶振幅(左、右)和聲門上運(yùn)動(dòng)(前后、左、右)的評(píng)估這5個(gè)觀察指標(biāo)的評(píng)委間一致性較低,不適合評(píng)估聲帶麻痹,故將它們從主觀視感知評(píng)分表去除,最終確定的評(píng)估表中6個(gè)觀察指標(biāo)在手術(shù)前后差異明顯(p均0.001)。該評(píng)估表檢驗(yàn)手術(shù)療效的效果良好。結(jié)論:單側(cè)聲帶麻痹動(dòng)態(tài)喉鏡視感知評(píng)分表的各項(xiàng)指標(biāo)評(píng)委之間一致性較好,且效果良好,說明最終制定的評(píng)估表可作為評(píng)估單側(cè)聲帶麻痹診斷及療效評(píng)估的有效評(píng)估工具。 第三部分頸袢神經(jīng)修復(fù)喉返神經(jīng)治療單側(cè)聲帶麻痹的療效分析。目的:研究頸袢主支喉返神經(jīng)修復(fù)術(shù)和頸袢分支喉返神經(jīng)修復(fù)術(shù)的遠(yuǎn)期療效;比較頸袢主支喉返神經(jīng)修復(fù)術(shù)與頸袢分支喉返神經(jīng)修復(fù)術(shù)的療效差異;研究不同失神經(jīng)病程對(duì)于頸袢主支喉返神經(jīng)修復(fù)術(shù)療效的影響。方法:收集自1996年3月至2008年3月接受頸袢喉返神經(jīng)修復(fù)術(shù)的資料完整的361例,分為頸袢主支喉返神經(jīng)修復(fù)術(shù)(主支組)和頸袢分支喉返神經(jīng)修復(fù)術(shù)(分支組)。主支組又按失神經(jīng)病程分為三個(gè)亞組:A組(失神經(jīng)病程為6-12個(gè)月組,156例)、B組(失神經(jīng)病程為13-24個(gè)月組, 108例)、C組(失神經(jīng)病程大于25個(gè)月組,45例)。采用動(dòng)態(tài)喉鏡評(píng)分表、嗓音RBH聽感知評(píng)估、嗓音客觀分析和肌電圖評(píng)估手術(shù)療效。結(jié)果:1、在主支組和分支組中,動(dòng)態(tài)喉鏡提示術(shù)后患側(cè)聲帶位置、聲門閉合程度、閉合商、患側(cè)聲帶邊緣直線性、聲帶振動(dòng)的對(duì)稱性和規(guī)律性均比術(shù)前明顯改善(p均0.001);術(shù)后患側(cè)甲杓肌最大隨意運(yùn)動(dòng)募集相均比術(shù)前明顯改善(p均0.001);術(shù)后聽感知評(píng)估粗糙聲、氣息聲和嘶啞聲均比術(shù)前明顯改善(p均0.001);術(shù)后基頻微擾、振幅微擾、噪諧比、最長聲時(shí)均比術(shù)前值明顯改善(p均0.001)。2、術(shù)后主支組的基頻微擾、振幅微擾、噪諧比均明顯小于分支組相應(yīng)的參數(shù)值(p均0.05);術(shù)后主支組的最長聲時(shí)要大于術(shù)后分支組相應(yīng)的參數(shù)值組相應(yīng)的參數(shù)值(p均0.05)。3、A組與B組比較,術(shù)后的基頻微擾、振幅微擾、噪諧比和最長聲時(shí)均無顯著差異(p均0.05);而A組術(shù)后的基頻微擾、振幅微擾、噪諧比均明顯小于C組而最長聲時(shí)明顯大于C組(p均0.001);B組術(shù)后的基頻微擾、振幅微擾、噪諧比均明顯小于C組而最長聲時(shí)明顯大于C組(p均0.001)。 結(jié)論:1、頸袢主支喉返神經(jīng)修復(fù)術(shù)和頸袢分支喉返神經(jīng)修復(fù)術(shù)均能明顯改善單側(cè)聲帶麻痹患者的嗓音且遠(yuǎn)期療效較滿意。2、頸袢主支喉返神經(jīng)修復(fù)術(shù)的療效要優(yōu)于頸袢分支喉返神經(jīng)修復(fù)術(shù)。3、失神經(jīng)2年內(nèi)行頸袢喉返神經(jīng)修復(fù)術(shù)的患者療效明顯優(yōu)于失神經(jīng)時(shí)間2年以上的患者。 第四部分對(duì)側(cè)頸袢神經(jīng)修復(fù)喉返神經(jīng)治療單側(cè)聲帶麻痹的療效分析。目的:研究對(duì)側(cè)頸袢喉返神經(jīng)修復(fù)術(shù)治療單側(cè)聲帶麻痹的療效。方法:自1996年3月至2008年3月接受對(duì)側(cè)頸袢喉返神經(jīng)修復(fù)術(shù)的資料完整的病例56例,采用動(dòng)態(tài)喉鏡評(píng)分表、嗓音RBH聽感知評(píng)估、嗓音客觀分析和肌電圖評(píng)估手術(shù)療效。結(jié)果:動(dòng)態(tài)喉鏡顯示術(shù)后聲門閉合、患側(cè)聲帶位置、患側(cè)聲帶邊緣、聲帶振動(dòng)規(guī)律性和對(duì)稱性、聲門閉合商均比術(shù)前明顯改善(p均0.001)。術(shù)后的粗糙聲、氣息聲和嘶啞聲比術(shù)前均有顯著改善(p均0.001)。術(shù)后基頻微擾、噪諧比、振幅微擾比術(shù)前均明顯減小(p均0.001)。術(shù)后最長聲時(shí)比術(shù)前明顯增大(p均0.001)。術(shù)后最大隨意運(yùn)動(dòng)募集相比術(shù)前明確改善(p均0.001)。結(jié)論:對(duì)側(cè)頸袢喉返神經(jīng)修復(fù)術(shù)可以改善單側(cè)聲帶麻痹患者的嗓音。所以它是一種較為理想的治療單側(cè)聲帶麻痹的手術(shù)方法。 全文結(jié)論:設(shè)計(jì)的標(biāo)準(zhǔn)化朗讀短文《害人終害己》的音素構(gòu)成比與中科院聲學(xué)研究所提出漢語相應(yīng)音素構(gòu)成比高度相似且易讀性良好。嗓音RBH聽感知評(píng)估系統(tǒng)漢語普通話版的信度和效度良好,可作為可靠的嗓音評(píng)估工具。單側(cè)聲帶麻痹動(dòng)態(tài)喉鏡主觀視感知評(píng)分表經(jīng)研究最終確定的各項(xiàng)評(píng)估指標(biāo)評(píng)委之間一致性較好,且效度良好,故該評(píng)估表可作為評(píng)價(jià)單側(cè)聲帶麻痹的的診斷與心理治療評(píng)估工具。頸袢主支喉返神經(jīng)修復(fù)術(shù)和頸袢分支喉返神經(jīng)修復(fù)術(shù)均能明顯改善單側(cè)聲帶麻痹患者的嗓音,且遠(yuǎn)期療效較滿意。頸袢主支喉返神經(jīng)修復(fù)術(shù)的療效要優(yōu)于頸袢分支喉返神經(jīng)修復(fù)術(shù)。失神經(jīng)2年內(nèi)行頸袢喉返神經(jīng)修復(fù)術(shù)的患者療效明顯優(yōu)于失神經(jīng)時(shí)間2年以上的患者。對(duì)側(cè)頸袢喉返神經(jīng)修復(fù)術(shù)可以改善單側(cè)聲帶麻痹患者的嗓音且遠(yuǎn)期療效較滿意。
[Abstract]:Unilateral vocal cord paralysis is a common disease in the otorhinolaryngology department. Its etiology is iatrogenic, tumor origin, idiopathic and traumatic. Patients often appear to be hoarseness, drinking and cough and other clinical symptoms. These symptoms seriously affect the quality of life of the patients. In clinical treatment of unilateral vocal cord paralysis, there are mainly vocal cord injections, nail shape. Chondroplasty, arytenoid adduction and laryngeal nerve repair, vocal cord injection, thyroid cartilage forming and arytenoid adduction can effectively improve the hoarseness, but the long term effect of the voice is not satisfactory because of the lack of reinnervation of the laryngeal muscles. With the development of microsurgical technique, vocal cord paralysis nerve repair The treatment of loop recurrent laryngeal nerve is one of the most commonly used laryngeal nerve repair in the world. However, it is reported that the number of cases of this operation is relatively small and lacks a study on the long-term effect. The influence of different course of denervation on the effect of the operation has not yet been reported. There is still a lack of conclusive evidence to prove the curative effect of recurrent laryngeal nerve repair on the lateral cervical loop. There are several points in this lesson: 1, the long-term effect of the repair of recurrent laryngeal nerve and recurrent laryngeal nerve repair of the loop branch of the loop of the neck; 2, the difference in the curative effect of the recurrent laryngeal nerve repair and the loop recurrent laryngeal nerve repair of the loop of the neck; 3, study The effect of different course of denervation on the efficacy of loop recurrent laryngeal nerve repair; 4. Evaluate the curative effect of recurrent laryngeal nerve repair to unilateral vocal cord paralysis. In order to correctly and comprehensively evaluate the curative effect, different evaluation methods should be used to evaluate the curative effect in a comprehensive and systematic way. The dynamic laryngoscope is an indispensable examination method to observe the structure and function of the larynx. So far, the literature still lacks a reliable and effective subjective evaluation method for the unilateral vocal cord paralysis. Therefore, this study tries to establish the Chinese voice RBH subjective auditory perception assessment system in Chinese. To verify its reliability and validity, a reliable and effective subjective visual perception assessment table for dynamic laryngoscope is set up and a comprehensive and systematic evaluation of the effect of recurrent laryngeal nerve repair. This study is divided into four parts:
The first part is to establish a Putonghua version of the RBH subjective voice perception assessment system in China.
Objective: to try to establish a Chinese language version of the Chinese voice RBH subjective auditory perception assessment system. Method: first design a text of Mandarin reading aloud, from the consonants, vowels and tones of the three components compared with the Chinese Academy of acoustics of the corresponding phoneme composition compared with the Chinese Academy of acoustics, and the text is easy to read. 40 cases of voice and 160 cases of pathological voice are continuous long vowels and reading sound samples, synchronous measurement of long vowel fundamental frequency perturbation, amplitude perturbation, noise harmonic ratio, the longest sound, the average airflow rate, voice barrier index. 3 experts are invited to formulate the Chinese speech version of the RBH subjective auditory perception evaluation system. Then 7 hearing judges are based on the initial RBH subjective. 160 voice samples were evaluated by the auditory perception assessment system. The correlation coefficient was used in the evaluation of the conformance test among the judges, while the Kappa coefficient was used to test the stability of the judges, and the validity was tested. The results showed that the consonants, vowels and tones of the standard Mandarin reading text were highly similar to the corresponding composition of Chinese, and were easy to read. The good.RBH three indicators of rough sound, breath sound and hoarseness are the self consistency of the 0.86,0.81,0.89. hearing judges in 0.45-0.72. In the hoarseness four levels, the fundamental frequency perturbation, the amplitude perturbation, the noise harmonic ratio, the longest sound, the average airflow rate, and the voice barrier index are compared between two adjacent levels. There were statistical significance (P 0.05). In the four grades of rough sound, the base frequency perturbation, the amplitude perturbation, the noise harmonic ratio between each adjacent two grades were statistically different (P 0.05). In the four grades of the breath sound, the noise harmonic ratio and the longest sound, the average airflow rate was statistically different between each adjacent grade (P 0.05 ).
Conclusion: the phoneme composition of the standardized reading short text < the victim's final victim > is similar to the Chinese corresponding phoneme composition of the Chinese Academy of Sciences and has a good readability. The reliability and validity of the Mandarin Chinese version of the voice RBH auditory perception evaluation system is good.
Objective: to establish a dynamic laryngoscope subjective score table for the second part of unilateral vocal cord paralysis. Objective: to establish a dynamic laryngoscope visual perception score of unilateral vocal cord paralysis for quantitative evaluation of vocal cord paralysis. Methods: according to the literature and the characteristics of vocal cord paralysis, the amplitude of vocal cords, the motion of the glottis, the position of the vocal cords, the degree of glottis closure, are selected. A preliminary assessment of the symmetry and regularity of the vocal cord vibration was made up. 48 cases of unilateral vocal cord paralysis with different degree of hoarseness were evaluated by 11 judges. The consistency between the judges was statistically analyzed with the intra group correlation coefficient and the Kappa coefficient was used to analyze the stability of the judges. 76 patients with unilateral vocal cord paralysis with surgical efficacy were tested as tests. The evaluation of the indicators of the assessment table had no difference before and after the operation. Results: the selection of the judges with high self stability was helpful to improve the consistency among the judges, with the results of the evaluation of the 5 highest self stability judges, 6 of the indexes were satisfactory, the position of the vocal cords, the degree of glottis closure, the closure of the quotient, and the risk of closure. The conformance of the sides of the lateral vocal cord, the symmetry and the regularity of the vibration of the vocal cords is between the 0.55-0.80. The evaluation of the 5 indexes of the vocal band amplitude (left, right) and the supra glottal motion (front, left, right) is low, and it is not suitable for evaluating the vocal cord paralysis. Therefore, they are removed from the subjective perception score table, and the final evaluation is determined. The 6 observation indexes were significantly different before and after the operation (P 0.001). The results of the assessment table were good. Conclusion: the evaluation table of the dynamic laryngoscope visual perception score of the unilateral vocal cord paralysis is good, and the effect is good. It shows that the final assessment table can be used as the diagnosis and treatment of unilateral vocal cord paralysis. An effective assessment tool for evaluation.
The third part of the loop nerve repair of recurrent laryngeal nerve in the treatment of unilateral vocal cord paralysis. Objective: To study the long-term effect of recurrent laryngeal nerve repair and loop recurrent laryngeal nerve repair, and to compare the difference between the main branch of the recurrent laryngeal nerve repair and the recurrent laryngeal nerve repair of the loop of the neck; to study the different course of the denervation. Methods: 361 cases of loop recurrent laryngeal nerve repair were collected from March 1996 to March 2008. The results were divided into three subdivisions of the recurrent laryngeal nerve repair (main branch) and loop recurrent laryngeal nerve repair (Branch Group). The main branch group was divided into three subgroups according to the denervation course. Group A (6-12 months of denervation course, 156 cases), group B (group of denervation for 13-24 months, 108 cases), group C (denervation course more than 25 months, 45 cases). Dynamic laryngoscope score, voice RBH auditory perception assessment, voice objective analysis and electromyography evaluation of surgical effect. Results: 1, dynamic laryngoscopy in main branch and branch group, dynamic laryngoscope hints. The position of the affected side of the vocal cord, the degree of closure of the glottis, the closed quotient, the straightness of the affected side of the vocal cord, the symmetry and regularity of the vocal cord vibration were significantly improved (P 0.001). The maximum voluntary recruitment of the dipper muscle after the operation was significantly better than that before the operation (P), and the auditory perception evaluation of rough sound, breath sound and hoarseness were compared after the operation. The preoperation was significantly improved (P 0.001); after the operation, the fundamental frequency perturbation, the amplitude perturbation, the noise harmonic ratio and the longest sound were significantly improved (P 0.001).2. The basic frequency of the main branch group after the operation was slightly disturbed and the amplitude was slightly disturbed, and the noise harmonic ratio was obviously smaller than the corresponding parameter value of the branch group (P 0.05); the longest sound of the main branch in the post operation was larger than the corresponding parameters of the post operation branch group. Value group corresponding parameter values (P 0.05).3, A group and B group compared with the base frequency perturbation, amplitude perturbation, noise harmonic ratio and the longest sound no significant difference (P 0.05), and A group after the basic frequency perturbation, amplitude perturbation, the noise harmonic ratio is obviously smaller than the C group and the longest sound is larger than C group (P 0.001); B group after the fundamental frequency perturbation, amplitude perturbation, noise noise, noise The harmonic ratio was significantly smaller than that in group C, but the longest time was significantly greater than that in group C (P 0.001).
Conclusion: 1, the recurrent laryngeal nerve repair and recurrent laryngeal nerve repair of the loop of the loop of the neck can obviously improve the voice of the patients with unilateral vocal cord paralysis and the long-term effect is satisfactory. The effect of the recurrent laryngeal nerve repair of the main branch of the loop of the neck is better than that of the loop recurrent laryngeal nerve repair of the loop of the loop of the larynx.3, and the patient with the loop recurrent laryngeal nerve repair in the 2 year of the denervation is.2. The curative effect is obviously better than that of the denervated patients for more than 2 years.
The fourth part is an analysis of the effect of recurrent laryngeal nerve repair with recurrent laryngeal nerve repair in the treatment of unilateral vocal cord paralysis. Objective: To study the effect of reversion of the lateral cervical loop of recurrent laryngeal nerve in the treatment of unilateral vocal cord paralysis. Methods: from March 1996 to March 2008, 56 cases of recurrent laryngeal nerve reversion to the lateral cervical loop were accepted, and the dynamic laryngoscope score was used. The voice RBH auditory perception assessment, the voice objective analysis and electromyography evaluation of the surgical effect. Results: the dynamic laryngoscope showed the closure of the glottis, the position of the vocal cords, the vocal cords edge, the vocal band vibration regularity and symmetry, the glottal closure was significantly improved (P 0.001) before the operation. The rough sound, breath sound and hoarseness were all before the operation. Significant improvement (P 0.001). The postoperative basal frequency perturbation, noise harmonic ratio and amplitude perturbation were significantly decreased (P 0.001). The longest sound time after operation was significantly higher than before operation (P 0.001). The maximum random movement after operation was clearly improved (P 0.001) before operation. Conclusion: the repair of recurrent laryngeal nerve in the lateral cervical loop can improve the patients with unilateral vocal cord paralysis. Voice. Therefore, it is an ideal surgical method for unilateral vocal cord paralysis.
The phoneme composition of the standardized reading short text < the victim of the victim > is similar to the corresponding phoneme composition proposed by the Institute of acoustics of the Chinese Academy of Sciences. The reliability and validity of the Chinese Mandarin version of the voice RBH auditory perception evaluation system is good. It can be used as a reliable voice assessment tool. The dynamic laryngoscope subjective perception score table has a good consistency and good validity between the evaluation indexes determined by the study. Therefore, the assessment table can be used as a diagnostic and psychotherapy assessment tool for the evaluation of unilateral vocal cord paralysis. The reconstructive surgery of the main loop of the neck and the loop of the loop of the loop of the larynx can be improved obviously. The voice of the unilateral vocal cord paralysis is more satisfactory. The effect of the recurrent laryngeal nerve repair of the main loop of the loop of the neck is better than the loop recurrent laryngeal nerve repair. The curative effect of the loop recurrent laryngeal nerve repair in 2 years of the denervation is obviously better than that of the patients with the denervated time more than 2 years. The repair of the recurrent laryngeal nerve in the lateral neck loop can be improved. The voice of patients with unilateral vocal cord paralysis has a long term effect.

【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2011
【分類號(hào)】：R767.91

【參考文獻(xiàn)】

相關(guān)期刊論文 前9條

1 鄭宏良，，李兆基，周水淼，蘭金山，王琪;長期失神經(jīng)支配的甲杓肌神經(jīng)修復(fù)術(shù)后收縮特性[J];第二軍醫(yī)大學(xué)學(xué)報(bào);1996年05期

2 陳世彩;鄭宏良;周水淼;李兆基;張速勤;沈小華;劉鋒;溫武;周蓉玨;;單側(cè)聲帶麻痹的外科治療[J];中國耳鼻咽喉頭頸外科;2006年11期

3 孫建軍，汪吉寶;離體初級(jí)聽覺神經(jīng)纖維機(jī)械損傷后的軸突再生[J];耳鼻咽喉頭頸外科;1995年02期

4 于萍,Giovanni Antoine;嗓音的客觀多參數(shù)分析與主觀聽覺分析相關(guān)性的研究[J];聽力學(xué)及言語疾病雜志;2003年03期

5 皇甫輝;孔維佳;龔樹生;王斌全;孔慶鳳;;幾種嗓音疾病的聲學(xué)分析和聽感知分級(jí)的評(píng)價(jià)[J];聽力學(xué)及言語疾病雜志;2007年03期

6 李紅艷;徐文;胡蓉;胡慧英;侯麗珍;張麗;;嗓音障礙疾病GRBAS聽主觀評(píng)估特點(diǎn)分析[J];聽力學(xué)及言語疾病雜志;2009年02期

7 張明星;溫武;周水淼;鄭宏良;耿麗萍;;單側(cè)聲帶麻痹患者嗓音主、客觀評(píng)估及其相關(guān)性分析[J];聽力學(xué)及言語疾病雜志;2010年04期

8 鄭宏良，李兆基，周水森，崔義，王琪，溫式，肖軾之;頸袢亞分支植入術(shù)治療單側(cè)喉麻痹的實(shí)驗(yàn)研究[J];中華耳鼻咽喉科雜志;1994年03期

9 鄭宏良，李兆基，周水森，崔毅;人喉外肌肌電圖研究[J];中華耳鼻咽喉科雜志;1995年02期

本文編號(hào)：1801576