喉内黏膜瓣防治声带前连合粘连的实验研究及临床应用  

Preventing and treating anterior commissure adhesion with mucosal flap:a study in canines and clinical cases

作　　者：李佳颖 李旭茂 崔西栋 胡鑫祺 虞鹏程 孙广滨 Li Jiaying;Li Xumao;Cui Xidong;Hu Xinqi;Yu Pengcheng;Sun Guangbin(Department of Otorhinolaryngology Head and Neck Surgery,Huashan Hospital of Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院耳鼻咽喉头颈外科,上海200040

出　　处：《中华耳鼻咽喉头颈外科杂志》2022年第2期161-167,共7页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的探索喉内黏膜瓣联合喉模技术对声带前连合粘连的防治效果。方法动物实验于2019年11月至2021年6月选取25只雄性比格犬,通过CO_(2)激光损伤比格犬声带前连合制造动物模型,再分别以喉内游离黏膜瓣+喉模(A组)、喉内带蒂黏膜瓣+喉模(B组)、单纯喉模(C组)覆盖创面,另设创面不处理组(D组)和假手术组(E组),每组5只;术后2周拆除喉模,术后4周观察喉镜下表现、声带长度及声门面积。临床应用方面,回顾性分析2019年1月至2021年1月就诊于复旦大学附属华山医院的16例声带前连合病变患者资料,所有患者行喉内黏膜瓣联合喉模技术防治前连合粘连治疗,分为游离黏膜瓣治疗组(10例)和带蒂黏膜瓣治疗组(6例)。2组患者术后每月随访声带粘连情况,术前及术后3个月进行嗓音分析检查。采用SPSS 20.0软件进行数据分析。结果全部25例比格犬手术顺利,术后无并发症。术后4周,相较A、C、D组,B组声带长度长(H=31.688,P<0.05),声门面积大(H=16.444,P<0.05);相较C、D组,A组声带长度长(H=20.936,P<0.05),声门面积大(H=11.786,P<0.05);A、B、E组术前、术后声带长度、声门面积比较无明显差异(t_(A组左声带长度)=2.636,t_(A组右声带长度)=2.582,t_(B组左声带长度)=2.707,t_(B组右声带长度)=2.673,t_(E组左声带长度)=0.370,t_(E组右声带长度)=0.821,t_(A组声门面积)=2.731,t_(B组声门面积)=2.753,t_(E组声门面积)=-0.529,P值均>0.05),C、D组术后4周较术前声带长度短、声门面积小(t_(C组左声带长度)=16.137,t_(C组右声带长度)=13.984,t_(D组左声带长度)=11.903,t_(D组右声带长度)=14.587,t_(C组声门面积)=10.280,t_(D组声门面积)=22.974,P值均<0.05)。临床16例前连合病变患者手术顺利,术后随访6~18个月,电子喉镜下全部病例均未出现前连合粘连。术后3个月患者基频微扰(Jitter)、振幅微扰(Shimmer)、噪谐比(NHR)均较术前减低(t_(带蒂jitter)=24.885,t_(带蒂shimmer)=22.643Objective To evaluate the effectiveness of mucosal flap combined with silicone keel for preventing and treating anterior commissure adhesion in canines and clinical cases.Methods A prospective experiment was performed from November 2019 to June 2021.Twenty five canines were randomly divided into 5 groups(A,B,C,D,E).Group A,B,C,D received anterior commissure injury by CO_(2) laser,then separately treated with free mucosal flap-keel complex,intralaryngeal mucosal flap-keel complex,silicone keels and without treatment,group E didn′t injure the vocal cord after intubation.The keel was removed after 2 weeks,the larynx was harvested after 4 weeks.The effectiveness of anterior commissure adhesion prevention was evaluated by manifestation under laryngoscope,standard vocal cord length and standard glottic area.A retrospective analysis was performed on sixteen patients with anterior commissure lesion,who underwent mucosal flap-keel technique in Huashan Hospital of Fudan University from January 2019 to January 2021(10 cases with free mucosal flap-keel complex and 6 cases with intralaryngeal mucosal flap-keel complex).All the patients underwent evaluation of laryngeal function included manifestation under laryngoscope each month and voice analysis before and 3 month after surgery.SPSS 20.0 software was used for statistical analysis.Results No surgery accident or complication happened in canines and patients.The standard vocal cord length and standard glottic area after 4 weeks in group B were significantly higher than those in group A,C,D(Hstandard vocal cord length=31.688,Hstandard glottic area=16.444,P<0.05).The standard vocal cord length and standard glottic area after 4 weeks in group A were also significantly higher than those in group C,D(Hstandard vocal cord length=20.936,Hstandard glottic area=11.786,P<0.05).The standard vocal cord length and standard glottic area after 4 weeks in group A,B,E were not significantly different to that before surgery(t_(A left standard vocal cord length)=2.636,t_(A right standard voca

关 键 词：喉狭窄 游离组织瓣 喉内带蒂黏膜瓣 

分 类 号：R767.91[医药卫生—耳鼻咽喉科]