颈袢前根-喉返神经吻合术治疗单侧声带麻痹的疗效分析  

Efficacy analysis of ansa cervicalis anterior root-recurrent laryngeal nerve anastomosis in the treatment of unilateral vocal cord paralysis

作　　者：高颖娜 陈世彩 王伟 李孟 朱敏辉 黄汝施 彭洁颖 李昊璞 郑宏良 GAO Yingna;CHEN Shicai;WANG Wei;LI Meng;ZHU Minhui;HUANG Rushi;PENG Jieying;LI Haopu;ZHENG Hongliang(Department of Otorhinolaryngology Head and Neck Surgery,the First Affiliated Hospital of Naval Medical University,Shanghai,200433,China)

机构地区：[1]海军军医大学第一附属医院(长海医院)耳鼻咽喉头颈外科,上海200433

出　　处：《临床耳鼻咽喉头颈外科杂志》2024年第10期907-911,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：国家自然科学基金面上项目(No:81970868)。

摘　　要：目的:探讨颈袢前根-喉返神经(recurrent laryngeal nerve,RLN)吻合术在治疗单侧声带麻痹(unilateral vocal fold paralysis,UVFP)中的应用和临床疗效。方法:前瞻性研究2018年1月-2022年1月我科收治的UVFP接受颈袢前根-RLN吻合术的患者92例,神经损伤病程6~24个月,采用动态喉镜、嗓音主观听感知评估(GRBAS)和嗓音障碍自我评估指数(VHI-10)、嗓音客观声学分析以及喉肌电图等评价该术式的疗效。结果:动态喉镜显示:术后12个月术侧声带虽均未恢复正常运动,但声带肌体积和肌张力均较术前明显改善,声带内移至正中位或近正中位,声门闭合、声带位置、声带边缘、声带振动对称性和规律性与术前比较均有明显改善(P<0.01);术后GRBAS的5个指标总嘶哑度、粗糙声、气息声、无力声、紧张声和VHI-10、嗓音客观声学参数(基频微扰Jitter、振幅微扰Shimmer、噪谐比NHR)与术前比较均明显降低,而最长声时(MPT)则明显长于术前,差异均有统计学意义(P<0.01);喉肌电图结果提示术后最大随意运动运动单位募集相较术前明显恢复(P<0.01),证实患侧喉肌获得有效的神经再支配。结论:颈袢前根-RLN吻合术能有效改善患者的嗓音功能,手术安全且疗效满意,是治疗单侧RLN损伤的理想方法。Objective Investigates the application and clinical efficacy of ansa cervicalis anterior root-recurrent laryngeal nerve(RLN)anastomosis in the treatment of unilateral vocal fold paralysis(UVFP).Methods A prospective study was conducted with 92 UVFP patients admitted to our department from January 2018 to January 2022 who received ansa cervicalis anterior root-RLN anastomosis.The course of nerve injury ranged from 6 to 24 months.Videostroboscopy,voice subjective auditory perceptual assessment(GRBAS),Voice Handicap Index(VHI-10),voice objective acoustic analysis and laryngeal electromyography(EMG)were used to evaluate the efficacy of the operation.Results Videostroboscopy showed that although the movement of vocal cords did not return to normal 12 months after operation,their volume and muscle tension were significantly improved and their positions were adducted to the median or near-median.Also the glottic closure,vocal cord position,vocal cord edge,symmetry and regularity of vocal cord vibration were significantly improved than pre-operation(P<0.01).The five indexes of GRBAS(Grade,Roughness,Breathiness,Asthenia,Strain)and VHI-10,as well as voice acoustic parameters(Jitter,Shimmer,NHR)post-operation were significantly reduced,while the maximum phonation time(MPT)was significantly longer(P<0.01).The results of laryngeal EMG indicated that the maximum voluntary motor unit recruitment(VMUR)post-operation was significantly recovered(P<0.01),which confirmed that the affected laryngeal muscle obtained effective nerve reinnervation.Conclusion Ansa cervicalis anterior root-RLN anastomosis can effectively improve the voice function of patients which is safe and satisfactory.It is an ideal method for the treatment of unilateral RLN injury.

关 键 词：颈袢前根 喉返神经修复 声带麻痹 嗓音障碍 

分 类 号：R767[医药卫生—耳鼻咽喉科]