基于CT评估声门型喉癌喉部分切除术后喉形态与临床功能的关系研究  

Study on the relationship between postoperative laryngeal morphology and clinical function in glottic laryngeal cancer based on CT assessment

作　　者：刘亚群 孙川 李光飞 LIU Yaqun;SUN Chuan;LI Guangfei(Department of Otolaryngology Head and Neck Surgery,Nanjing Tongren Hospital,Nanjing,Jiangsu,211102,China)

机构地区：[1]南京同仁医院耳鼻咽喉头颈外科,江苏南京211102

出　　处：《中国耳鼻咽喉头颈外科》2023年第12期758-762,共5页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的 探究基于CT评估的声门型喉癌喉部分切除术后喉形态与临床功能的关系。方法 选取2020年3月~2023年3月90例行喉部分切除术的声门型喉癌患者(观察组),术后随访时均行CT扫描,测量声门面积(glottaarea,GA)、声门横径(glottal width,GW)、声门前后径(glottal depth,GD)、声门下面积(subglottic area,SGA)、舌骨-环状距离(hyoidcricoid distance,HCD),统计术后呼吸、发音、吞咽功能情况,比较观察组与50名健康志愿者(对照组)喉CT形态学参数、嗓音声学参数测量结果,分析喉CT形态学参数与拔管时间、吞咽功能分级、嗓音声学参数的相关性。结果 90例患者随访时均已拔除气管套管,拔管时间7~22(14.35±3.67)d;动态喉镜观察显示,58例患者发/i:/音时声门完全关闭,32例患者发/i:/音时声门关闭不全;随访时所有患者均可经口进食,吞咽功能评估结果:0级62例(68.89%),1级23例(25.56%),2级5例(5.55%);观察组术后随访喉CT可见声带、喉室、室带等结构不同程度缺损,声门形态呈“V”形、“U”形或不规则形异常,部分患者声门裂略微扩大或偏移,观察组术后喉CT形态学参数GA、GW、GD、SGA、HCD均小于对照组(P均<0.05),观察组中术后发/i:/音时声门完全关闭者GA、GW、GD、SGA、HCD均大于声门关闭不全者(P均<0.05);嗓音声学分析显示,观察组术后基频(F0)、最长发声时间(MPT)均低于对照组(P均<0.05),频率微扰(Jitter)、振幅微扰(Shimmer)均高于对照组(P均<0.05);相关性分析结果显示,观察组患者术后喉CT形态学参数GA、GW、GD、SGA、HCD与吞咽功能分级均呈负相关性(P<0.05),而与嗓音学参数F0、MPT均呈正相关性(P<0.05),与拔管时间、Jitter、Shimmer均呈负相关性(P<0.05)。结论 声门型喉癌行垂直喉部分切除术后,喉CT形态学参数GA、GW、GD、SGA、HCD与患者的呼吸、发音、吞咽功能密切相关,可有助于指导临床治疗和康复训练。OBJECTIVE To explore the relationship between laryngeal morphology and clinical function after partial laryngectomy for glottic laryngeal cancer,as assessed by CT.METHODS This study included 90 patients with glottic laryngeal cancer who underwent partial laryngectomy between March 2020 and March 2023(observation group).Postoperative follow-up included CT scans,measuring glottal area(GA),glottal width(GW),glottal depth(GD),subglottic area(SGA),and hyoid-cricoid distance(HCD).Postoperative respiratory,phonation,and swallowing functions were recorded.The study compared CT morphological parameters and voice acoustic parameters between the observation group and 50 healthy volunteers(control group) and analyzed the correlation of laryngeal CT morphological parameters with decannulation time,swallowing function grading,and voice acoustic parameters.RESULTS All 90 patients were decannulated at follow-up,with decannulation times ranging from 7 to 22(14.35±3.67) days.Laryngoscopy showed that 58 patients had complete glottal closure while phonating/i:/,whereas 32 had incomplete closure.At follow-up,all patients were able to eat orally.Swallowing function assessment results were:grade 0 in 62 cases(68.89%),grade 1 in 23 cases(25.56%),and grade 2 in 5 cases(5.55%).Postoperative laryngeal CT in the observation group revealed varying degrees of structural deficiencies in the vocal cords,laryngeal ventricle,and ventricular band.Glottal morphology appeared as 'V','U' shaped,or irregularly abnormal,with some patients showing slight enlargement or deviation of the glottal slit.CT morphological parameters GA,GW,GD,SGA,HCD in the observation group were all smaller than those in the control group(P<0.05).Those in the observation group with complete glottal closure during/i:/phonation had larger GA,GW,GD,SGA,HCD than those with incomplete closure(P<0.05).Voice acoustic analysis revealed that postoperative F0,MPT were lower in the observation group compared to the control group(P<0.05),while Jitter and Shimmer were higher(P<0.05).Spear

关 键 词：喉肿瘤 外科手术 声门型喉癌 喉部分切除术 喉形态 呼吸功能发音功能 吞咽功能 

分 类 号：R739.65[医药卫生—肿瘤]