不同干预时间进行声带注射对甲状腺术后单侧声带麻痹的临床疗效  

Different intervention time affects the effect of vocal cord injection on unilateral vocal cord paralysis after thyroid surgery

作　　者：刘家佳[1] 李仕晟[1] 朱刚才[1] 彭鸥[1] 李苗 尹丹辉 杨新明[1] 唐青来[1] 贺湘波[1] 彭霞[1] LIU Jiajia;LI Shisheng;ZHU Gangcai;PENG Ou;LI Miao;YIN Danhui;YANG Xinming;TANG Qinglai;HE Xiangbo;PENG Xia(Department of Otolaryngology Head and Neck Surgery,the Second Xiangya Hospital,Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院耳鼻咽喉头颈外科,湖南长沙410011

出　　处：《中国耳鼻咽喉颅底外科杂志》2020年第4期377-381,共5页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：国家自然科学基金面上项目(81870711);长沙市科技计划项目(kq1901121)。

摘　　要：目的甲状腺手术后导致的单侧声带麻痹(UVCP)影响患者的声音质量和生活质量,喉内声带注射可以有效地提高患者的声音质量,本研究观察术后不同时间进行声带注射治疗UVCP的疗效。方法回顾分析2017年1月—2019年4月湘雅二医院耳鼻咽喉头颈外科就诊的因甲状腺手术后UVCP早期(1个月内)或晚期(6个月以上)行声带注射喉成型的患者31例。所有患者均行局麻电子喉镜下颈外径路透明质酸声带注射喉成型术,其中18例在术后1个月内进行声带注射(A组),13例患者在术后6个月以上进行声带注射(B组)。对所有患者治疗前后进行动态喉镜、嗓音分析、GRBAS评估、嗓音障碍指数量表(VHI-10)测评。对比两组患者治疗前后各组数据。结果两组患者治疗前临床特征、嗓音分析结果、GRBAS评估得分、VHI-10测评得分差异无统计学意义。两组患者注射后1个月内复查动态喉镜均可见声带闭合良好,B组有4例患者患侧声带未见明显黏膜波。A组注射患者VHI-10量表评分、MPT与B组患者差异无统计学意义;GRBAS评估得分、jitter、shimmer均低于B组。结论甲状腺手术后UVCP患者早期行声带注射治疗效果优于晚期注射,其原因可能是声带长时间失去接触性刺激和失神经性营养导致的声带功能层次的损伤。Objective To observe the effect of vocal cord injection on unilateral vocal cord paralysis at different intervention time.Methods From Jan 2017 to April 2019,a total 31 patients with unilateral vocal cord paralysis after thyroid surgery underwent vocal cord injection in our department.Vocal cord lateral injection of hyaluronic acid was performed through the cricothyroid membrane under fibrolaryngoscope in all the patients.Among them,18 cases received vocal cord injection within 1 month after thyroidectomy(the early intervention group),and 13 received injection later than 6 months after thyroidectomy(the late intervention group).Strobolaryngoscope,voice analysis,GRBAS assessment,and VHI-10 scale were performed in all patients before and after treatment.The data of the two groups were compared.Results There were no significant differences in clinical features,voice analysis results,GRBAS scores and VHI scores between the two groups before treatment.Strobolaryngoscope examination showed improved vocal cord insufficiency one month after injection in both groups,and disappeared mucosal wave at the affected vocal cord in 4 patients of the late intervention group.One month after injection,there were no significant differences in VHI-10 score and MPT between the two groups,while the GRBAS score,jitter and shimmer of the early intervention group were lower than those of the late intervention group.Conclusion For unilateral vocal cord paralysis after thyroidectomy,early vocal cord injection can achieve better therapeutic effect than late injection,which may be due to the damage of vocal function caused by prolonged loss of contact stimulation and denervation.

关 键 词：单侧声带麻痹 声带注射 早期 甲状腺手术 透明质酸 

分 类 号：R767.92[医药卫生—耳鼻咽喉科]