Montgomery假体植入治疗单侧声带麻痹的疗效研究  

The surgical effectiveness of montgomery thyroplasty implant on patients with unilateral vocal fold paralysis

作　　者：李孟 郑宏良 葛平江[2] 朱敏辉 王伟 刘菲 陈世彩 Li Meng;Zheng Hongliang;Ge Pingjiang;Zhu Minhui;Wang Wei;Liu Fei;Chen Shicai(Department of Otorhinolaryngology Head and Neck Surgery,the First Affiliated Hospital of Navy Medical University,Shanghai 200433,China;Department of Otorhinolaryngology Head and Neck Surgery,Guangdong Provincial People′s Hospital,Guangzhou 510080,China)

机构地区：[1]海军军医大学第一附属医院耳鼻咽喉头颈外科,上海200433 [2]广东省人民医院耳鼻咽喉头颈外科,广州510080

出　　处：《中华耳鼻咽喉头颈外科杂志》2020年第11期1027-1031,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的初步探讨Montgomery假体植入的Ⅰ型甲状软骨成形术治疗单侧声带麻痹的效果。方法回顾性分析2015年5月至2019年3月在海军军医大学第一附属医院和广东省人民医院耳鼻咽喉头颈外科接受Montgomery假体植入的Ⅰ型甲状软骨成形术的46例单侧声带麻痹患者的临床病例资料,其中男24例,女22例,年龄23~77岁。评估方法包括GRBAS听感知评估、声学参数[包括基频微扰(Jitter)、振幅微扰(Shimmer)、噪谐比(NHR)]以及最长发声时间(MPT)等。声学参数和MPT数据采用配对t检验进行统计学分析,GRBAS数据采用秩和检验进行分析。结果术后动态喉镜结果显示,44例患者的患侧声带明显向中线移位,发音时声门裂隙较术前明显减小;2例患者的声门裂缩小不明显。GRBAS听感知评估各参数除紧张声(S)外评分较术前明显降低,声学参数(Jitter、Shimmer、NHR)较术前也均明显减小,MPT较术前明显延长,差异均有统计学意义(P值均<0.001)。2例声门裂缩小不明显的患者行修正性手术。所有患者均未发生严重并发症。结论Montgomery假体植入的甲状软骨成形术可有效地改善单侧声带麻痹患者嗓音,安全性高,值得推广。Objective To investigate the efficacy of type I thyroplasty with Montgomery prosthesis implantation for the treatment of unilateral vocal fold paralysis.Methods From May 2015 to March 2019,46 patients(24 males,22 females,with age range of 23-77)with unilateral vocal fold paralysis underwent thyroplasty with Montgomery prosthesis implantation in the Department of Otorhinolaryngology Head and Neck Surgery in both the First Affiliated Hospital of Navy Medical University and Guangdong Provincial People’s Hospital.The assessment methods included GRBAS auditory perception assessment,acoustic analysis such as Jitter,Shimmer,NHR and maximum phonation time(MPT).Results Postoperative videostroboscopy observed the displacement of paralyzed vocal fold to the midline in 44 cases as well as significantly reduced glottic fissures during phonation.In the other 2 cases,glottic fissure did not reduce significantly.Compared with preoperative data,the scores of all parameters in GRBAS auditory perception assessment were lower except the parameter S,and the acoustic analysis parameters(jitter,shimmer,NHR)were smaller,and MPT was longer.All the difference was statistically significant(P<0.001).Revision surgery was performed in 2 patients with poor results.No serious complications occurred in all the cases.Conclusions For the patients with unilateral vocal fold paralysis who are not suitable for the laryngeal reinnervation surgery due to old age or long course of denervation,thyroplasty with Montgomery prosthesis implantation can effectively improve the voice of patients with high safety,which is worthy of promotion.

关 键 词：声带麻痹 Montgomery假体 甲状软骨成形术 手术疗效 

分 类 号：R767.91[医药卫生—耳鼻咽喉科]