喉显微手术与传统术式治疗声带任克水肿的对照研究  

A Comparative Study Between Laryngeal Microsurgery and Traditional Operation in the Treatment of Reinke's Edema of Vocal Cords

作　　者：黄建强[1] 洪育明[1] 石小伟[1] 

机构地区：[1]福建医科大学附属第二医院耳鼻咽喉头颈外科,泉州362000

出　　处：《中国微创外科杂志》2016年第12期1096-1099,1112,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨支撑喉镜喉显微外科手术治疗声带任克水肿的临床疗效。方法 2004年1月-2009年12月24例声带任克水肿行支撑喉镜下声带黏膜剥脱术（传统组）;2010年1月-2015年12月32例声带任克水肿行支撑喉镜显微镜下声带外侧黏膜下切开微瓣术（喉显微组）。2组均于术前及术后1周、3周、8周行电子喉镜检查及嗓音主观评估GRBAS（1979年日本言语语音学会制定,G为总嘶哑度Grade,R为粗糙程度Roughness,B为气息声Breathness,A为无力程度Asthenia,S为紧张程度Strain）,回顾性比较2组术后声带创面愈合、声嘶改善时间和嗓音改善程度。结果与传统组相比,喉显微组治疗后声嘶改善早,声带黏膜上皮恢复早[声嘶改善时间（7.3±1.9）d vs.（11.3±2.7）d,t=-6.481,P=0.000;声带上皮恢复时间（12.2±3.1）d vs.（20.1±3.4）d,t=-9.062,P=0.000];2组术前嗓音评估G、R、B均无显著性差异,术后1周、3周、8周喉显微组G、R、B均明显低于传统组（术后8周,G：1.0±0.8 vs.1.6±0.2,t=-3.584,P=0.000;R：1.0±0.9vs.1.5±0.4,t=-2.536,P=0.014;B：1.0±0.6 vs.1.4±0.5,t=-2.647,P=0.011）。喉显微组治愈24例,有效5例,无效3例,传统组分别为11、7、6例,差异有显著性（Z=-2.239,P=0.025）,但2组有效率差异无显著性[90.6%（29/32）vs.75.0%（18/24）,χ^2=1.459,P=0.227]。结论支撑喉镜喉显微手术治疗声带任克水肿在术后嗓音恢复时间及声带黏膜上皮创面愈合等方面比传统手术更佳,发音质量明显提高。Objective To investigate the clinical efficacy of the self-retaining laryngeal microsurgical operation in the treatment of Reinke＇s edema of vocal cords. Methods There were 24 cases of Reinke＇s edema who were treated with self-retaining laryngoscope mucosal stripping surgery of vocal cords from January 2004 to December 2009（ traditional group）,while another group of32 cases of Reinke＇s edema were treated with self-retaining laryngoscopic microsurgery lateral submucosal incision micro-flap operation of vocal cords from January 2010 to December 2015（ laryngeal microsurgery group）. The two groups were executed with electronic laryngoscopy and subjective voice evaluation GRBAS（ The Speech and Language Institute of Japanese in 1979,G： Grade,R：Roughness,B： Breathness,A： Asthenia,S： Strain） in pre-operation and post-operation（ 1 week,3 weeks,8 weeks）. The wound healing time of vocal cords,hoarseness improved time and voice improvement were retrospectively compared between the two groups.Results The patients in laryngeal microsurgery group had earlier voice hoarse improvement and more rapid mucosal epithelial of vocal cords recovery time in post-operation as compared with the patients in the traditional group [voice improving time,（ 7. 3 ± 1. 9） d vs.（ 11. 3 ± 2. 7） d,t =- 6. 481,P = 0. 000; mucosal epithelial of vocal cords recovery time,（ 12. 2 ± 3. 1） d vs.（ 20. 1 ± 3. 4） d,t =- 9. 062,P = 0. 000]. The results of pre-operative voice evaluation with GRBAS showed no significant differences between the two groups,but the results of post-operative evaluation of each session（ 1 week,3 weeks,8 weeks） showed that the main data were statistically different. The GRBAS score of laryngeal microsurgery group was lower than that of traditional group in post-operation,especially after 8 weeks（ 8 weeks after post-operation,G： 1. 0 ± 0. 8 vs. 1. 6 ± 0. 2,t =- 3. 584,P = 0. 000; R： 1. 0 ± 0. 9 vs.1. 5 ± 0. 4,t =- 2. 536,P = 0. 014; B： 1. 0 ± 0. 6 vs. 1. 4 ± 0. 5,t =

关 键 词：任克水肿 声带 喉显微手术 声带黏膜剥脱术 嗓音外科 

分 类 号：R767.91[医药卫生—耳鼻咽喉科]