内镜下CO_(2)激光杓状软骨切除术在声带后端切断术失败的患者再手术中的疗效分析  

Evaluation of the effect of endoscopic CO_(2) laser arytenoidectomy on re-operation for failed posterior cordotomy

作　　者：彭洁颖 郑宏良 李孟 王伟 朱敏辉 江昊 张才云 高颖娜 陈梦婕 陈世彩 PENG Jieying;ZHENG Hongliang;LI Meng;WANG Wei;ZHU Minhui;JIANG Hao;ZHANG Caiyun;GAO Yingna;CHEN Mengjie;CHEN Shicai(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917-922,共6页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨内镜下CO_(2)激光辅助下杓状软骨切除术治疗不同状态的双侧声带麻痹的疗效。方法:纳入95例2009年1月-2022年12月于海军军医大学第一附属医院(长海医院)行内镜下CO_(2)激光杓状软骨切除术治疗不同状态的双侧声带麻痹的患者,其中59例首次声门开大术即采用内镜下CO_(2)激光杓状软骨切除术为A组,36例行2次CO_(2)激光辅助下声带后端切断术未能成功拔管,再行内镜下CO_(2)激光杓状软骨切除术为B组。统计分析2组患者手术前后吞咽功能,声门大小及嗓音主、客观指标等,并评估临床疗效。结果:A组患者一次手术拔管率为84.75%,二次手术拔管率为66.67%,总拔管率为94.92%。B组患者一次手术拔管率为86.11%,二次手术拔管率为60.00%,总拔管率为94.44%。2组患者术前及术后吞咽功能、声门大小、嗓音评估各项指标比较差异均无统计学意义(P>0.05)。2组患者组内手术前后比较,术后吞咽功能、发声时声门闭合度、听感知评估中G(总嘶哑度)、A(无力度)、B(气息声)显著变差,分级增大;吸气时声门后部最大横径显著增大,VHI-10总分明显较术前升高;基频微扰(Jitter)、振幅微扰(Shimmer)较术前显著增大,谐噪比减小,最长声时较术前显著缩短,差异均有统计学意义(P<0.05)。2组患者术后R(粗糙声)、S(紧张度)则较术前比较差异均无统计学意义(P>0.05)。结论:内镜下CO_(2)激光杓状软骨切除术术后在一定程度上损伤嗓音质量,但能有效缓解双侧声带麻痹患者的呼吸困难,对于行CO_(2)激光声带后端切断术未能成功拔管的患者,内镜下CO_(2)激光杓状软骨切除术是一种行之有效的再次手术方式,既能保持较高的拔管率,又能保留一定的嗓音功能。Objective To analyze the efficacy of endoscopic CO_(2)laser arytenoidectomy in treating bilateral vocal cord paralysis.Methods Ninety-five patients who underwent endoscopic CO_(2)laser arytenoidectomy for bilateral vocal cord paralysis at the First Affiliated Hospital of Naval Medical University(Changhai Hospital)of Shanghai from January 2009 to December 2022 were included in this study.Among them,59 patients underwent endoscopic CO_(2)laser arytenoidectomy as their first glottic enlargement surgery(Group A),while 36 patients,who had previously undergone two unsuccessful CO_(2)laser-assisted posterior cordotomies,underwent endoscopic CO_(2)laser arytenoidectomy as a subsequent surgery(Group B).Swallowing function,electronic laryngoscopy,perceptual voice evaluation,and objective voice analysis indicators were statistically analyzed before and after surgery to evaluate clinical efficacy.Results The extubation rate after the first surgery was 84.75%in Group A and 86.11%in Group B,with total extubation rates of 94.92%and 94.44%,respectively.There were no significant differences between the two groups in preoperative and postoperative swallowing function,glottic size,or various voice evaluation indicators(P>0.05).Within-group comparisons showed that postoperative swallowing function,glottic closure during phonation,perceptual evaluations of G(grade of hoarseness),A(asthenia),and B(breathiness)significantly worsened,with increased grades.The maximum transverse diameter of the posterior glottis during inspiration significantly increased,and the VHI-10 score was significantly higher postoperatively.Jitter,shimmer,and the harmonics-to-noise ratio significantly deteriorated,and maximum phonation time significantly shortened(P<0.05).No significant differences were observed in postoperative R(roughness)and S(strain)compared to preoperative values(P>0.05).Conclusion Endoscopic CO_(2)laser arytenoidectomy can impair voice quality to some extent but effectively alleviates breathing difficulties in patients with bilateral vocal

关 键 词：声带麻痹 杓状软骨切除术 声带后端切断术 吞咽功能 嗓音质量 

分 类 号：R767[医药卫生—耳鼻咽喉科]