支撑喉镜显微镜下微瓣显微缝合技术在喉良性病变中的应用  

Application of microsurgical flap suture technique under self-retaining laryngoscope for vocal cord benign lesions

作　　者：何双八[1] 孙国燕[1] 张庆翔[1] 于振坤[1] 

机构地区：[1]东南大学医学院附属南京同仁医院耳鼻咽喉头颈外科,江苏南京211102

出　　处：《中国耳鼻咽喉颅底外科杂志》2017年第5期427-430,共4页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：江苏省"双创"人才基金资助(苏人才办[2015]26号);江苏省自然科学基金资助(BK20161116);南京市2015年度科技发展计划资助(201503057)

摘　　要：目的探讨支撑喉镜显微镜下微瓣显微缝合技术在喉良性病变中的应用效果。方法 46例患者,其中声带任克氏水肿12例,声带广基息肉24例,声带囊肿10例,手术中利用微瓣技术,在切除病变组织的同时,保留声带微瓣并进行支撑喉镜显微镜下声带黏膜的显微缝合。术前、术后1个月和术后3个月对患者进行频闪喉镜检查,并进行嗓音GRBAS评估、嗓音障碍指数(voice handicap index,VHI)主观评分及客观嗓音分析,主要为基频微扰(Jitter)、振幅微扰(Shimmer)、最长发声时间(maximun phonation time,MPT)及嗓音障碍严重程度指数(dysphonia severity index,DSI)等。结果所有患者手术顺利,安全切除病变组织后,保留声带黏膜微瓣,均成功的进行了支撑喉镜显微镜下的显微缝合声带黏膜,术后患者声带黏膜光滑,声带闭合情况良好,黏膜波接近于正常;主客观嗓音分析提示患者嗓音质量较术前明显改善。结论对于声带良性病变合适的病例,支撑喉镜显微镜下微瓣显微缝合技术有利于患者声带黏膜的保护,术后患者嗓音质量及患者满意度得以提高。Objective To investigate the effect of the microsurgical flap suture technique under self-retaining laryngoscope for vocal cord benign lesions.Methods 46 cases of vocal cord benign lesions（including 12 cases of Reinke＇s edema,24 of vocal cord polyp and 10 of vocal cord cysts） underwent microsurgical flap suture under self-retaining laryngoscope.Resection of the pathological tissues and microscopic suture of the mucosal flaps under self-retaining laryngoscope were performed to all the patients.Before operation,one month and 3 months after operation,all the patients underwent stroboscopy,GRBAS evaluation,voice handicap index（VHI） and so on.For voice acoustic analysis,parameters such as Jitter,Shimmer,maximum phonation time（MPT）,dysphonia severity index（DSI） and so on,were included.Results All the patients underwent the operation safely.The lesions were resected microscopically and the mucosal flaps were sutured smoothly by the microsurgical flap suture technique.Postoperative stroboscopy detected smooth mucosa and favourable closure of vocal cords with almost normal mucosal wave in all the patients.Voice analysis revealed that the postoperative parameters were better than the preoperative ones.Conclusion The microsurgical flap suture technique under self-retaining laryngoscope is effective in protecting vocal cord mucosa and improving the voice quality in patients with vocal cord benign lesions.

关 键 词：声带 新生物 微瓣 显微缝合 嗓音质量 

分 类 号：R767.92[医药卫生—耳鼻咽喉科] R767.91[医药卫生—临床医学]