显微支撑喉镜手术联合抑酸治疗声带任克水肿疗效观察  

Efficacy of microscopic laryngeal surgery combined with gastric acid inhibition in treatment of Reinke’s edema

作　　者：邝韶景 李忠万 方红雁 杨贵军 KUANG Shaojing;LI Zhongwan;FANG Hongyan;YANG Guijun(Department of Otolaryngology,Head and Neck Surgery,Chongqing General Hospital,Chongqing,400014,China)

机构地区：[1]重庆市人民医院耳鼻咽喉头颈外科,重庆400014

出　　处：《第三军医大学学报》2021年第19期1939-1943,共5页Journal of Third Military Medical University

基　　金：重庆市社会事业与民生保障科技创新专项(cstc2018jscx-msyb1194)。

摘　　要：目的探讨显微支撑喉镜手术联合抑酸治疗声带任克水肿的疗效。方法回顾性分析2016年4月至2019年12月我科47例术前评估存在咽喉反流的声带任克水肿患者临床资料,根据患者术后抑酸治疗与否分为抑酸组(n=27)和非抑酸组(n=20),选取同期56例正常噪音者作为健康对照组。对比分析术前及术后1、3、6个月基频(F0)、基频微扰(jitter)、噪/谐比(NHR)、振幅微扰(shimmer)等嗓音功能指标及噪音障碍指数(voice handicap index, VHI)量表评分的变化。结果术前两组患者F0低于健康对照组,jitter、NHR、shimmer均高于健康对照组(P<0.05)。术后第3、6个月抑酸组F0大于非抑酸组,jitter、shimmer、NHR小于非抑酸组,与健康对照组相比差异有统计学意义(P<0.05)。术后1、3、6个月,抑酸及非抑酸组F0逐渐升高,其余3个嗓音声学指标均有一定程度的降低,声音嘶哑逐渐减轻。术后1个月时,抑酸及非抑酸组之间上述指标无明显差异;在第3、6个月时,抑酸组F0大于非抑酸组,NHR、jitter及shimmer小于非抑酸组,差异有统计学意义(P<0.05),抑酸及非抑酸组与健康对照组相比仍存在明显差异(P<0.05)。术前两组患者VHI各项评分高于健康对照组,差异具有统计学意义(P<0.05);术后患者单项评分以及总评分逐渐降低,各时间点抑酸组与非抑酸组各项评分无明显差异,6个月时两组各项评分与健康对照组比较均无明显差异。结论声带任克水肿通过手术治疗效果显著,对伴有咽喉反流的患者术后给予抑酸治疗可加快嗓音恢复。Objective To investigate the efficacy of microscopic laryngeal surgery, otherwise known as microlaryngoscopy, combined with gastric acid inhibition in the treatment of Reinke’s edema. Methods The clinical data of 47 Reinke’s edema patients with pharynx reflux preoperatively in our department from April 2016 to December 2019 were collected and retrospectively analyzed. These patients were divided into 2 subgroups according to receiving gastric acid inhibition(n=27) or not(n=20). At the same period, 56 normal subjects(control group) were selected for examination and investigation. The changes of voice function and voice handicap index(VHI) score were compared and analyzed before and in 1, 3 and 6 months after surgery. Results Before operation, fundamental frequency(F0) was significantly lower, and fundamental frequency perturbation(jitter), noise/harmonic ratio(NHR) and amplitude perturbation(shimmer) were obviously higher in the patient group than the normal group(P<0.05). At 3 and 6 months after operation, F0 was notably higher, while the levels of jitter, shimmer and NHR were remarkably lower in the acid inhibition subgroup than the non-acid inhibition subgroup, and significant differences were observed in above indicators between the former subgroup and the control group(P<0.05). In 1, 3 and 6 months after operation, F0 was gradually increased and the other 3 voice acoustic indicators were decreased at a certain degree in the both subgroups, with hoarseness gradually reduced. In 1 month after operation, there were no statistical differences in above indicators between the 2 subgroups, but F0 was higher while NHR, jitter and shimmer were lower in the acid inhibition subgroup than the non-acid inhibition subgroup at 3 and 6 months(P<0.05), though great differences were observed among the 2 subgroups and normal control. The scores of VHI in the patient group before operation were higher than those in the control group(P<0.05). The patient group had significantly higher scores and total scores in VHI than the c

关 键 词：显微支撑喉镜手术 抑酸 任克水肿 咽喉反流 

分 类 号：R767.4[医药卫生—耳鼻咽喉科] R767.91[医药卫生—临床医学]