不同术式治疗T1a期声门型喉癌的嗓音功能评估  

Voice Analysis after Transoral Laser Cordectomy and Radiofrequency Coblation Therapy for T1a Glottic Cancer

作　　者：王燕[1] 屈季宁[1] 周涛[1] 华清泉[1] 雷薇薇[1] 舒婧 Wang Yan;Qu Jining;Zhou Tao;Hua Qingquan;Lei Weiwei;Shu Jing(Department of Otolaryngology-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,武汉430060

出　　处：《听力学及言语疾病杂志》2023年第6期509-513,共5页Journal of Audiology and Speech Pathology

摘　　要：目的对比CO_(2)激光、低温等离子刀切除术两种术式治疗早期声门型喉癌的嗓音恢复情况。方法回顾性分析2017年1月~2019年12月在武汉大学人民医院进行CO_(2)激光和等离子刀切除术治疗的42例T1aN0M0期声门型喉癌患者的临床资料,分为两组,A组20例,采用低温等离子刀切除术治疗;B组22例,采用CO_(2)激光切除术治疗。根据病变范围,按内镜下声带切除术分类标准指南,40例患者采用Ⅲ型手术,2例采用Ⅳ型手术。术中取切缘进行冰冻病理检查,阴性即可结束手术。手术前及术后3、6、9及12个月应用嗓音障碍指数VHI-10、听感知评估GRABS及多维嗓音分析软件对患者嗓音功能进行评估,动态喉镜检查观察声带形态及黏膜波,比较两组结果。结果①两组患者术后3个月时,jitter、shimmer及NHR数值明显增高,随着时间推移,jitter、shimmer及NHR数值逐渐降低,到9个月以后,以上观察指标趋于稳定。②术后9个月时,B组嗓音功能恢复优于A组。主观听感知方面,B组术后嗓音障碍程度轻于A组;两组间jitter值差异有统计学意义(P<0.05)。③动态喉镜检查:B组术后声带闭合、运动的对称性、黏膜波、振动规律性优于A组(P<0.05)。结论对T1a期声门型喉癌患者,CO_(2)激光术后患者嗓音功能恢复情况优于低温等离子射频手术。Objective To compare the acoustic parameters after microscopic cordectomy using CO_(2) laser cordectomy and radiofrequency coblation in T1a glottic cancer.Methods We conducted a retrospective review of vocal function after treatment of T1a glottic cancer in 42 patients from Jannary 2017 to December 2019.A total of 20 cases underwent radiofrequency coblation(group A),and 22 cases underwent CO_(2) microscopic laser excision(group B).Voice analysis was performed before surgery and postoperative period(3,6,9,12 months).Acoustic,perceptual(grade,roughness,breathiness,asthenia,strain scale),and subjective voice analysis using the voice handicap index(VHI-10)was conducted.Videolaryngoscopy was performed to evaluate vocal fold and mucosal wave for each subject.Results①At 3 months follow-up,jitter,shimmer and NHR indexes were increased significently in both groups.After 3 month,these indexes decreased progressively.Indexes were stabilized after 9 months.②Superior vocal outcomes and subjective vocal perception were found in group B over group A after 9 month(P<0.05).③Patients in group B improved significantly when compared with patients in group A in the closure of vocal cords,symmetry of vibration,the mucosal wave and vibration regularity of the vocal cords.Conclusion CO_(2) laser postoperative voice function recovery is better.Radiofrequency coblation is inferior to CO_(2) laser in cutting precision and voice function recovery.For patients with T1a glottic cancer,the vocal voice function recorvry is better with CO_(2) laser excision than radiofrequency coblation.

关 键 词：声门型喉癌 CO_(2)激光 等离子刀 嗓音功能 

分 类 号：R739.65[医药卫生—肿瘤]