特发性单侧声带麻痹预后及喉肌电图特征分析  

Prognosis and Laryngeal Electromyography Features of Idiopathic Unilateral Vocal Fold Paralysis

作　　者：胡蓉[1] 徐文[1] 林毓鸿 程丽宇 Hu Rong;Xu Wen;Lin Yuhong;Cheng Liyu(Department of Otorhinolaryngology-Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing,100730,China)

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,北京100730

出　　处：《听力学及言语疾病杂志》2021年第4期382-387,共6页Journal of Audiology and Speech Pathology

基　　金：北京市自然科学基金(7172051);北京市医院管理局“青苗”计划专项经费(QML20170201);北京市东城区优秀人才培养基金联合资助。

摘　　要：目的探讨特发性单侧声带麻痹患者的预后及喉肌电图特征。方法回顾性分析29例(14~75岁,中位年龄36岁)经喉肌电图证实为特发性单侧声带麻痹患者的临床资料,左侧麻痹22例,右侧麻痹7例,初诊病程为20天~10年。于初诊及初诊后3个月、6个月、1年、2年、3年进行嗓音的主观听感知评估(GRBAS)及频闪喉镜检查,初诊及初诊后6个月行喉肌电图检查,比较嗓音嘶哑程度、声带运动及喉返神经损伤程度变化。结果初诊时24例(82.8%)患者为中重度声嘶(G2~3级),频闪喉镜下见声带运动受限7例(24.1%),声带固定22例(75.9%),其中固定于旁正中位12例,固定于外展位10例。喉肌电图显示喉返神经功能完全损伤9例(31.0%),不全损伤20例(69.0%),其中内收支功能正常1例(3.4%),不全损伤16例(55.2%),完全损伤12例(41.4%);外展支功能正常6例(20.7%),不全损伤9例(31.0%),完全损伤14例(48.3%)。随访3年,21例(72.4%)患者声嘶改善(15例为患侧声带运动改善,6例为健侧代偿),其中嗓音恢复正常9例(31.0%)(7例患侧声带运动恢复正常,2例为健侧代偿);喉返神经不完全损伤患者的声嘶恢复率(35.0%)明显高于完全损伤患者(11.1%)。15例(51.7%)患者声带运动改善(运动恢复正常7例,24.1%)。20例(69.0%)患者喉肌电图改善,其中2例(10.0%)患者喉肌电图恢复正常,喉返神经内收支功能的改善率(69.0%)高于外展支(34.5%)。结论本组特发性单侧声带麻痹患者喉返神经不全损伤的比率较高,患者的声嘶改善率为72.4%,声带运动改善率为51.7%;半年复查时患者喉肌电图的改善率为69.0%,喉返神经内收支功能的改善情况明显好于外展支。Objective To investigate the prognosis and laryngeal electromyography(LEMG)features in patients with idiopathic unilateral vocal fold paralysis.Methods The clinical data of 29 patients with idiopathic unilateral vocal fold paralysis confirmed by laryngeal electromyography were included restrospectively studied.There were 16 males and 13 females,aged from 14 to 75 years.There were 22 cases of left vocal folds palsy and 7 cases of right vocal folds palsy.The course of the disease was 20 days to 10 years.The subjective auditory perception GRBAS scale was used for evaluating the degree of hoarseness.The movement and fixed position of vocal fold were observed under strobolaryngoscope.And the injury degree of recurrent laryngeal nerve(RLN)was evaluated by LEMG.The follow-up time was 3 months,6 months,1 year,2 years and 3 years after the initial diagnosis.The degree of hoarseness and strobolaryngoscopy were evaluated during each follow-up.LEMG was performed 6 months after the initial diagnosis.The changes in the degree of hoarseness,vocal fold movement and the injury degree of RLN were compared.Results Twenty-four patients(82.8%)suffered moderate to severe hoarseness.Seven cases(24.1%)had limited vocal fold movement,and 22 cases’(75.6%)vocal folds were fixed.Among them,12 vocal folds were fixed in the paramedian position and 10 vocal folds were fixed in the abductor position.RLN dysfunction was incompletely injured in 20 cases(69.0%)and completely injured in 9 cases(31.0%).For the adductor branch of RLN,there was 1 case(3.4%)with normal function,16 cases(55.2%)with incomplete injury and 12 cases(41.4%)with complete injury.For the abductor branch of RLN,6 cases(20.7%)with normal function,9 cases(31.0%)with incomplete injury and 14 cases(48.3%)with complete injury.During the follow-up period of 3 years,vocal quality improved in 21 cases(72.4%)(15 cases showed improvement of vocal fold movement on the affected side and 6 cases showed compensation on the uninjured side),of which 9 cases(31.0%)returned to normal voice(7 ca

关 键 词：声带麻痹 特发性 喉返神经 喉肌电图 预后 

分 类 号：R[医药卫生]