喉环状软骨上部分切除环舌骨会厌固定术后患者发声功能评估及其影响因素分析  

The Objective Voice Assessment and Analysis of Impact Factors after Supracricoid Partial Laryngectory with Cricohyoidoepiglottopexy

作　　者：赵峰[1] 黄小英[1] 赵冲 苏纪平[1] Zhao Feng;Huang Xiaoying;Zhao Chong;Su Jiping(Department of Otolaryngology-Head and Neck Surgery,the first Affiliated Hospitalof Guangxi Medical University,Nanning,530021,China)

机构地区：[1]广西医科大学第一附属医院耳鼻咽喉头颈外科,南宁530021 [2]西南医科大学附属医院耳鼻咽喉头颈外科

出　　处：《听力学及言语疾病杂志》2019年第4期382-387,共6页Journal of Audiology and Speech Pathology

摘　　要：目的 客观评价喉环状软骨上部分切除环舌骨会厌固定术(supracricoid partial laryngectomy with cricohyoidoepiglottopexy,SCPL-CHEP)后患者的发声功能,探讨影响其嗓音质量的相关因素。方法 选取2009年6月至2014年12月行SCPL-CHEP手术 1.5 ~68个月后(中位时间为 11.5 个月)的46例喉癌患者为研究组,另选取20例正常成年男性为对照组,分别采集并比较两组对象发声的基频(F0)、基频微扰(jitter)、振幅微扰(shimmer)、最长发声时间(maximum phonation time,MPT),结合患者年龄、T分期、肿瘤分型、术中重建披裂、保留的环杓单位完整性个数、术后放疗及术后时间等临床资料,分析可能影响新喉发音的相关因素。结果 SCPL-CHEP术后患者的嗓音F0、MPT低于正常同龄男性(P < 0.05),jitter、shimmer值则高于正常同龄男性(P < 0.05);Spearman’s相关性分析表明,F0与T分期、术中重建披裂、肿瘤分型呈负相关(r =-0.307 , P = 0.038;r =-0.390 , P = 0.007;r =-0.291 , P = 0.050);jitter与术后放疗呈负相关(r =-0.329 , P = 0.026);shimmer与术后时间呈正相关(r = 0.332 , P = 0.024),与肿瘤分型呈负相关(r =-0.332 , P = 0.024);MPT与术后时间呈正相关(r = 0.296 , P = 0.046)。结论 SCPL-CHEP术后患者嗓音质量差,术前病变范围越广,患者术后发音时F0下降、shimmer升高越明显;术后放疗可降低jitter;随着术后时间的延长,患者MTP延长。Objective To objectively evaluate the quality of the voice after supracricoid partial laryngectomy with cricohyoidoepiglottopexy (SCPL-CHEP),and combine the clinical data to explore the impact factors.Methods A total of 46 patients with laryngeal cancer from June 2009 to December 2014 for SCPL-CHEP were included in this study.From 1.5 to 68 months after surgery (median time 11.5 months),objective acoustics were performed in all the patients to collect 4 acoustic parameters:F0,jitter,shimmer,and MPT.We studied the clinical data to investigate related factors that may affect the neolarynx phonatory function.Results Voice parameters of F0 and MPT in the CHEP group were lower than those in the normal males of the same age (P<0.05).Jitter and shimmer were higher than those of the normal males of the same age (P<0.05).Spearman's correlation analysis showed that F0 was negatively correlated with T stage,intraoperative reconstruction,and tumor type (r=-0.307 ,P = 0.038;r=-0.390 ,P = 0.007;r=-0.291 ,P = 0.050).Jitter was negatively correlated with postoperative radiotherapy (r=-0.329 ,P = 0.026).Shimmer was positively correlated with postoperative time (r= 0.332 ,P = 0.024),and negatively correlated with tumor type (r=-0.332 ,P = 0.024).MPT was positively correlated with postoperative time (r= 0.296 ,P = 0.046).Conclusion The voice quality of patients who underwent SCPL-CHEP is poor.The postoperative performance is low-pitched and high hoarseness in the patients who have wide lesion ranges.Postoperative radiotherapy can reduce jitter characterized by low hoarseness and roughness.With the prolongation of postoperative time,the patient's ability to continue vocalization is improved with MTP extended.

关 键 词：喉癌 环舌骨会厌固定术 嗓音质量 

分 类 号：R764.3[医药卫生—耳鼻咽喉科]