自体甲状软骨植入I型甲状软骨成形术治疗单侧声带麻痹  

Using Thyroid Cartilage in Type I Thyroplasty for Treating Unilateral Vocal Cord Paralysis

作　　者：王燕[1] 屈季宁[1] 周涛[1] 明伟[1] 华清泉[1] 雷薇薇[1] Wang Yan;Qu Jining;Zhou Tao;Ming Wei;Hua Qingquan;Lei Weiwei(Department of Otorhinolaryngology Head and Neck Surgery,Renmin Hospital of Wuhan University,Wuhan,430060,China)

机构地区：[1]武汉大学人民医院耳鼻咽喉-头颈外科中心咽喉科,武汉430060

出　　处：《听力学及言语疾病杂志》2022年第2期176-179,共4页Journal of Audiology and Speech Pathology

摘　　要：目的分析应用自体甲状软骨植入I型甲状软骨成形术治疗单侧声带麻痹的疗效。方法对32例单侧声带麻痹患者于局麻下行甲状软骨板开窗,取自体甲状软骨植入(置于甲状软骨内软骨膜与甲状软骨板之间,缝合固定),使患侧声带内移;术前及术后1、3、6个月分别行电子喉镜检查、嗓音障碍指数量表(VHI)评估及嗓音声学分析,比较治疗前后结果,分析疗效。结果所有患者术后即刻声嘶改善,术后一个月时喉镜下见患侧声带不同程度由旁正中位移至或接近中线位,26例患者发声时声门闭合良好,6例患者声门后部遗留1 mm小缝隙;术后3、6个月时喉镜检查结果与术后一个月时无明显差异。术后1个月时,32例患者中嗓音恢复正常、明显好转、好转和无改善分别为14、12、4和2例;患者的VHI评分由81.50±11.58分降至28.59±9.05分,嗓音声学分析结果显示,基频微扰(jitter)由4.43%±1.01%降至1.23%±0.85%,振幅微扰(shimmer)由12.65%±1.01%降至4.83%±1.02%,标准化噪声能量(NNE)由-4.59±1.53 dB降至-10.09±1.75 dB,噪谐比(NHR)由0.31±0.02降至0.16±0.01;术后3个月及术后6个月时上述VHI评估及噪音声学分析指标均保持持续稳定。随访1~4年无一例植入物脱出。结论采用自体甲状软骨作为移植物的改良I型甲状软骨成形术治疗单侧声带麻痹,能明显提高患者嗓音质量,无排异反应,操作简单、安全有效。Objective To study the effect of using thyroid cartilage in type I thyroplasty for treating unilateral vocal cord paralysis.Methods A total of 32 cases of unilateral vocal cord paralysis due to various causes were treated with type I thyroplasty.Laryngostroboscopy was performed before and after the operation.Voice handicap index(VHI),acoustic measurements(Kay Elemetrics Multi-Speech program)were applied to evaluate the patients’voice quality before and after operation.Results Hoarseness was improved in all patients immediately after the operation.One month after the operation,the affected vocal cords were shifted to or near the midline by different degrees by laryngostroboscopy.The glottis closed well in 26 patients,and a small gap of 1 mm was left at the back of glottis in 6 patients.There was no significant difference in the results of laryngoscopy between 3 and 6 months after operation and 1 month after operation.One month after the operation,the voice returned to normal,significantly improved,improved and no improved in 14,12,4 and 2 cases respectively.One month after operation,the VHI score of the patients decreased from 81.50±11.58 to 28.59±9.05 overall.The acoustic analysis showed that,the jitter decreased from 4.43±1.01 to 1.23±0.85,shimmer decreased from 12.65±1.01 to 4.83±1.02,NNE decreased from-4.59±1.53 dB to-10.09±1.75 dB.NHR decreased from 0.31±0.02 to 0.16±0.01 respectively.It remained stable 3 months and 6 months after operation.There was no implant prolapse during 1~4 years follow-up.Conclusion The improved type I thyroid cartilage plasty with autologous thyroid cartilage as graft in the treatment of unilateral vocal cord adduction paralysis can significantly improve the voice quality of patients,without rejection reaction,simple operation,safe and effective,which is worthy of clinical promotion.

关 键 词：单侧声带麻痹 I型甲状软骨成形术 甲状软骨 

分 类 号：R767.64[医药卫生—耳鼻咽喉科]