支撑喉镜内微瓣显微缝合技术在声带任克水肿中的应用  

Application of the laryngoscope microsurgical flap suture technique for vocal cords Reinke's edema

作　　者：何双八[1] 倪会 孙国燕[1] 严敏 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：《中国医学文摘（耳鼻咽喉科学）》2017年第6期290-292,共3页Chinese Medical Digest(Otorhinolaryngology)

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：目的声带任克水肿是临床常见的嗓音疾病,常采用冷器械、激光切除,病变切除后遗留下较大的手术缺损和创面,在声带手术创面的修复过程中造成声带瘢痕的形成,对患者嗓音造成不利影响;而任克水肿黏膜很富裕,切除黏膜下组织和部分多余的黏膜后,对声带手术创面进行黏膜覆盖并进行缝合,消除声带的手术创面,减少瘢痕的形成,有利于患者嗓音的恢复。本文探讨支撑喉镜内微瓣显微缝合技术在声带任克水肿中的应用效果。方法声带任克水肿患者18例,术中利用微瓣技术,沿声带上平面黏膜做一纵行切口,分离黏膜,去除黏膜下胶冻样物后,将黏膜覆盖手术创面,切除多余黏膜,在支撑喉镜显微镜下进行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、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)、最大发声时间(maximum phonation time,MPT)等。结果所有患者手术顺利,切除黏膜下水肿组织及多余的黏膜,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。结论对于声带任克水肿的患者,支撑喉镜内微瓣显微缝合技术有利于患者声带手术创面的消除和声带黏膜的保护,术后配合综合治疗,患者嗓音质量及患者满意度得以提高。Objective In clinical practice,vocal cords Reinke＇s edemas are often resected by cold instruments or CO2 laser. After operation,the surgical defects are always a little big and the scars occur which will result in a worse voice quality. This research is to investigate the effect of the laryngoscope microsurgical flap suture technique on vocal cords Reinke＇s edemas. Methods 18 cases of vocal cords Reinke＇s edema underwent laryngoscope microsurgical flap suture. Their edema tissues of vocal cord were resected,and the mucosal flaps were sutured under laryngoscope after removal of the excess mucous membranes. The stroboscope,GRBAS evaluation,voice handicap indexes（VHI）of all patients were performed pre-operation and 1 month and 3 months post-operation. Voice acoustic analysis,including jitter,shimmer,Maximum Phonation Time（MPT）,were performed. Results All the patients underwent the operations safely. The vocal cords Reinke＇s edema tissue were resected microscopically and the mucosal flaps were sutured smoothly by the microsurgical flap suture technique. 2 days postoperatively,the smooth and closure of the vocal cords were well. The mucosal wave of vocal cords was closed to the normal. Parameters of voice analysis after operation in 1 month and 3 months were better than pre-operation. Conclusion The microsurgical flap suture technique is effective in eliminating the wounds and protecting the mucosa of the vocal cords. This technique is good to improve the voice quality for the vocal cords Reinke＇s edemas.

关 键 词：声带 水肿 微瓣 显微缝合 嗓音质量 

分 类 号：R767.105[医药卫生—耳鼻咽喉科]