微瓣显微缝合联合嗓音训练治疗声带任克水肿的疗效观察  

The Clinical Efficacy of Microsurgical Flap Suture Technique Combined with Vocal Therapy on Patients with Rreinke’s Edema of the Vocal Cord

作　　者：范志涛 苏慧 王学霞 刘朝兵 FAN Zhitao;SU Hui;WANG Xuexia(Department of Otolaryngology-Head and Neck Surgery,Hebei Eye Hospital,Xingtai City,Hebei Province 054001;不详)

机构地区：[1]河北省眼科医院耳鼻咽喉头颈外科,河北省邢台市054001 [2]邢台市人民医院心脏外科

出　　处：《医学理论与实践》2021年第6期916-919,共4页The Journal of Medical Theory and Practice

摘　　要：目的:探讨微瓣显微缝合联合嗓音训练治疗声带任克水肿的疗效。方法:选取于2016年4月—2019年8月间首诊为声带任克水肿并进行微瓣显微缝合手术治疗的20例资料完整患者为研究对象(手术组),术后将其随机分为两组:单纯手术组10例行常规治疗;联合干预组10例于术后第2周在常规治疗的基础上联合嗓音训练。另随机选取10例无嗓音疾患且经电子喉镜检查声带无形态异常的吸烟男性作为对照(对照组)。手术组患者分别在术前、术后2周、1个月、3个月进行嗓音主观评分和嗓音声学参数检测,对照组同时进行嗓音声学参数检测。结果:手术组术后3个月嗓音声学各指标较术前明显改善,然而,基频微扰(Jitter)、振幅微扰(Shimmer)、MPT(最长发音时间)与对照组间差异具有统计学意义(P<0.05)。对手术组和对照组两组患者的嗓音参数进行重复测量方差分析,时间因素和组别因素对两组患者术前、术后2周~3个月嗓音变化起作用。研究对象声学参数值变化随时间变化而不同,Jitter、Shimmer和NHR值呈现出下降趋势,F0和MPT值呈现出上升趋势,差异均有统计学意义(P<0.05)。联合干预组的G评分、R评分、VHI、Jitter、MPT声学参数均低于单纯手术组,差异具有统计学意义(P<0.05)。结论:声带任克水肿常为多种病因叠加,尽管微瓣显微缝合有利于患者声带手术创面的消除和黏膜恢复,但其黏膜创面较大,术后短期内较难恢复至正常发音,术后联合嗓音训练综合治疗,有助于进一步改善患者的嗓音质量。Objective:To explore the clinical efficacy of microsurgical flap suture technique combined with vocal therapy on patients with reinke’s edema of the vocal cord.Methods:Totally 20 cases of vocal cords reinke’s edema admitted between April 2016 and August 2019 were selected and randomly divided into surgical alone group and combined-therapy group.In addition,10 cases of healthy males were randomly selected as the control group.Before and after 2 weeks,1 month,3 months of intervention,treatment groups were evaluated through voice acoustic analysis and using the GRBAS evaluation,voice handicap index(VHI)and so on.While the voice acoustic parameters were detected in the control group at the same time.Results:After 3 months of operation,the acoustic parameters were significantly improved compared with those before operation.However,there were still significant differences in Jitter,Shimmer and MPT between the two groups(P<0.05).The acoustic parameters between treatment group and control group were analyzed by test of repeated measurement ANOVA.Time factor and group factor played an important role in the changes of voice before operation and postoperative 2~12 weeks.The acoustic parameters changed with time,Jitter,Shimmer and NHR values showed a downward trend,F0 and MPT values appeared an upward trend,the differences were statistically significant(P<0.05).The total score of hoarseness(G.R score),VHI,Jitter,MPT parameters of the combined-therapy group were lower than those of the surgical alone group,the difference was statistically significant(P<0.05).Conclusion:Vocal cords reinke’s edema is usually caused by many factors.Although microsurgical flap suture technique is effective in eliminating the wounds,protecting the mucosa of the vocal cords,the larger mucosal wound is difficult to recover to normal pronunciation in a short term.Postoperative combined voice training and comprehensive treatment is helpful to further improve the voice health of reinke’s edema patients.

关 键 词：任克水肿 微瓣 显微缝合 嗓音训练 嗓音声学分析 

分 类 号：R767.4[医药卫生—耳鼻咽喉科]