手术联合A型肉毒毒素甲杓肌注射治疗成人声带小结的疗效分析  

The Effects of Phonosurgery for Vocal Fold Nodule Combined with Botulinum Toxin of Type A Injection in Adults

作　　者：张庆翔[1] 胡慧英[1] 何双八[1] 孙国燕[1] 于振坤[1] Zhang Qingxiang;Hu Huiying;He Shuangba;Sun Guoyan;Yu Zhenkun(Department of Otolaryngology Head and Neck Surgery, Southeast University Medical College,Affiliated Nanjing Tongren Hospital, Nanjing, 211102, China)

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,南京211102

出　　处：《听力学及言语疾病杂志》2018年第1期25-28,共4页Journal of Audiology and Speech Pathology

基　　金：南京市2016年度科技发展计划项目资助(201605068)

摘　　要：目的探讨手术联合A型肉毒毒素甲杓肌注射治疗成人声带小结的临床疗效。方法回顾性分析2012年8月至2016年3月收治的76例手术治疗的成人声带小结患者的临床资料,其中2012年8月~2014年8月的病例为单纯手术组,共40例,均在全麻支撑喉镜下行喉显微手术切除声带小结;2014年9月~2016年3月的病例为联合注射组,共36例,均在喉显微手术同时行A型肉毒毒素0.25~0.5U双侧甲杓肌注射。两组均于术前及术后6个月分别进行频闪喉镜及电子喉镜检查,采用嗓音主观感知GRBAS评估系统的G分级及嗓音障碍指数(voice handicap index,VHI)进行嗓音评估,记录最长发声时间(maximum phonation time,MPT)、基频微扰(jitter)、振幅微扰(shimmer)和嗓音障碍严重程度指数(dysphonia severity index,DSI),比较两组疗效。结果单纯手术组痊愈5例,好转28例,无效7例,有效率82.50%(33/40);联合注射组痊愈30例,好转6例,有效率100%(36/36)。单纯手术组术后声门闭合良好22例,闭合不全18例;联合注射组声门闭合良好30例,好转但仍闭合不全6例,两组术后声门闭合情况比较差异有统计学意义(P<0.05)。联合注射组术后VHI、MPT、jitter、shimmer及DSI改善明显,两组之间比较,除了G分级外,差异均有统计学意义(均为P<0.05)。结论手术切除联合A型肉毒毒素甲杓肌注射治疗成人声带小结在恢复声带形态的同时调节甲杓肌肌张力,改善声带振动,是一种有效的治疗方式。Objective To investigate the effects of phonosurgery combined with botulinumtoxinof type A injection in adults with vocal nodules.Methods A total of76adults with diagnosis of vocal nodules were studied in this experiment.They were divided into two group according to the different treatments:the surgery group(n=40),and the group with the combined botulinum toxin of type A injection(n=36).Preoperative and postoperative examinations consisted of electronic laryngoscope,stroboscopic laryngoscope,voice assessments of subjective and objective evaluations using GRBAS classification and voice disorder index(VHI).The evaluation parameters were the longest phonation time(MPT),jitter and shimmer and dysphonia severity index(DSI).The results from the two groups were compared.Results There were5cases cured,28cases improved and7cases of now effects in the surgery group.The effective rate was82.5%.There were30cases cured and6cases improved in the combined injection group with the effective rate of100%.There were22cases with good glottis closure and18cases with incomplete closure in the surgery group postoperatively;in the combined injection group,30cases glottis closed well and6cases still closed incompletely.The differences of postoperative VHI,MPT,jitter,shimmer and DSI in addition to G were significant different between the two groups.Conclusion Phonosurgery combined with botulinum toxin of type A injection is an effective way for the treatment of vocal fold nodules in adults.

关 键 词：声带小结 喉显微手术 A型肉毒毒素 甲杓肌注射 

分 类 号：R767.41[医药卫生—耳鼻咽喉科]