摘要
目的探讨单侧声带麻痹导致发音障碍患者行声带外侧自体脂肪注射术治疗的临床长期随访观察结果。方法回顾性队列研究2003年7月至2020年6月就诊于首都医科大学附属北京同仁医院耳鼻咽喉头颈外科的因单侧声带麻痹致发音障碍并于支撑喉镜下行自体脂肪声带外侧注射术的163例患者临床资料, 其中男86例, 女77例, 年龄9~73(34.50±12.94)岁。比较患者手术前后主观听感知评估(GRBAS评估)、客观声学评估、嗓音障碍指数(VHI)量表评价及频闪喉镜检查。所有患者随访1~18年, 中位随访时间6年。应用SPSS 22.0软件进行统计学分析。结果 163例患者中术前轻度声嘶(G1)17例(10.4%), 中重度声嘶(G2~3)146例(89.6%);频闪喉镜下见患侧声带呈弓形, 固定于旁正中位或外展位, 声门闭合不良。术后139例患者(85.3%)发声恢复正常(G0), 18例(11.0%)患者轻度声嘶(G1), 6例患者(3.7%)中度声嘶(G2)。其中, 131例患者(80.4%)声嘶明显改善, 29例患者(17.8%)声嘶轻度改善, 3例患者(1.8%)声嘶无明显改善。患者的客观声学参数中频率微扰(Jitter)、振幅微扰(Shimmer)、噪谐比(NHR)和最长发声时间(MPT)均有明显改善, VHI评分亦明显好转。频闪喉镜下见患侧声带内移, 声门闭合改善, 声带黏膜波接近或恢复正常。当脂肪注射量为3.0~4.5 ml时, 术后3个月内患者的主观听感知评分G、R、B、A改善更为明显, VHI和MPT均自术后1年明显好转。双侧声带注射时, 自术后1个月起B、A评分较单侧注射明显改善(术后1个月单双侧注射对比:tB评分=1.42, tA评分=1.51, P值均<0.05)。结论声带外侧声门旁间隙自体脂肪注射填充手术治疗单侧声带麻痹引起的发音障碍远期疗效良好, 手术疗效与脂肪注射剂量和注射侧别有关。
Objective To investigate the long-term outcomes of patients with unilateral vocal fold paralysis resulting in dysphonia treated with lateral vocal fold autologous fat injection.To analyze the factors that may affect the long-term efficacy of the procedure.Methods From July 2003 to June 2020,163 patients(86 males and 77 females),aged 9-73 years(mean(34.50±12.94)years)with unilateral vocal fold paralysis resulting in dysphonia underwent transoral laryngoscopic injection of autologous fat into the lateral vocal folds.Subjective auditory perception assessment(GRBAS scale),objective acoustic assessment,voice handicap index(VHI)evaluation and stroboscopic laryngoscopy were compared before and after the surgery.Patients were followed up for 1 to 18 years,with median follow-up time of 6 years.SPSS 22.0 software was used for statistical analysis.Results Of 163 patients,17 patients(10.4%)had mild hoarseness(G1)and 146 patients(89.6%)had moderate to severe hoarseness(G2-3).Stroboscopic laryngoscopy revealed an arch-shaped vocal fold on the affected side,fixed in the paramedian position or abduction position,with obvious glottic closure fissure.Postoperatively,voice recovered to normal(G0)in 139 patients(85.3%),mild hoarseness(G1)in 18 patients(11.0%)and moderate hoarseness(G2)in 6 patients(3.7%).Of these,131 patients(80.4%)showed significant improvement in hoarseness,29 patients(17.8%)showed mild improvement and 3 patients(1.8%)showed no significant improvement in hoarseness.Objective acoustic parameters of Jitter,Shimmer,NHR and MPT improved significantly,as did VHI scores.Stroboscopic laryngoscopy showed medialization of the affected vocal folds,improved vocal fold closure and normal or nearly normal vocal fold mucosal waves.With a fat injection volume of 3.0-4.5 ml,the patient′s subjective auditory perception scores of G,R,B and A improved more significantly within 3 months after surgery,and both VHI and MPT were significantly better since 1 year after surgery.With bilateral vocal fold injection,the B and A scores improved significantly from 1 month postoperatively compared to unilateral injections(unilateral vs.bilateral injection 1 month post-operation,tB scores=1.42,tA scores=1.51,P<0.05).Conclusions The long-term efficacy of autologous fat injection in the paraglottic space for the treatment of unilateral vocal fold paralysis was stable.The efficacy of the surgery was related to the amount of fat injected,unilateral or bilateral of the injection.
作者
胡蓉
徐文
程丽宇
李雪岩
王海舟
Hu Rong;Xu Wen;Cheng Liyu;Li Xueyan;Wang Haizhou(Department of Otorhinolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University Key Laboratory of Otolaryngology Head and Neck Surgery(Capital Medical University),Ministry of Education,Beijing 100730,China)
出处
《中华耳鼻咽喉头颈外科杂志》
CSCD
北大核心
2023年第1期28-36,共9页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
关键词
声带麻痹
声门闭合不良
声带注射填充术
自体脂肪
发音障碍
Vocal fold paralysis
Glottis closure deficiency
Vocal fold injection and augmentation
Autologous fat
Dysphonia
