喉肌电图在手术后声带运动障碍中的诊断价值  

Diagnostic value of laryngeal electromyography in vocal cord dysfunction after surgery

作　　者：李汝婷 刘耀凤 李秋菊 肖旭平[1] 马丽娟[1] LI Ruting;LIU Yaofeng;LI Qiuju;XIAO Xuping;MA Lijuan(Department of Otolaryngology Head and Neck Surgery,the Hunan Provincial People’s Hospital,the First Affiliated Hospital of Hunan Normal University,Changsha 410005,China)

机构地区：[1]湖南省人民医院、湖南师范大学附属第一医院耳鼻咽喉头颈外科,湖南长沙410005

出　　处：《中国耳鼻咽喉颅底外科杂志》2024年第6期89-94,共6页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：湖南省教育厅基金项目(21A0040);湖南省卫生健康委员会基金项目(202207012592)。

摘　　要：目的探讨喉肌电图(LEMG)在手术后声带运动障碍(VCD)中的诊断价值。方法回顾38例全麻手术后出现VCD的患者,结合相关病史、频闪喉镜、喉部CT、嗓音的主观听感知评估(GRBAS)及LEMG的结果,进行诊断和治疗分析。结果38例患者分为喉返神经麻痹组20例,环杓关节脱位组18例。嗓音分析显示33例为中重度声嘶(G2~3级)。喉部CT显示环杓关节脱位组,呈前内侧脱位或者后外侧脱位;喉返神经麻痹组环杓关节未见异常。LEMG检查显示喉返神经麻痹组20例患者中,13例患者喉返神经不完全受损,4例患者喉返神经完全受损,3例患者喉上神经同时受损;环杓关节脱位18例患者中,11例患者LEMG结果正常,7例LEMG存在轻度异常。喉返神经麻痹组20例患者中,16例患者经过药物加嗓音训练或者声带脂肪注射治疗,嗓音质量明显改善(G0~1级);4例患者未接受治疗,单侧依靠对侧声带代偿作用,嗓音恢复欠佳(G3级)。环杓关节脱位组18例患者,给予环杓关节拨动复位术,术后配合嗓音训练,17例取得满意效果(G0~1级)。结论手术后出现VCD是术后声嘶的主要原因,LEMG能对喉返神经麻痹及环杓关节脱位进行定性诊断,能够指导临床治疗,有助于患者尽快康复。Objective To investigate the diagnostic value of laryngeal electromyography(LEMG)in vocal cord dysfunction(VCD)after surgery.Methods A retrospective analysis was performed on 38 patients with VCD after general anesthesia,which were involved in a comprehensive diagnostic and treatment process based on relevant medical history,flexible laryngoscopy,three-dimensional CT of the larynx,subjective perceptual assessment of voice GRBAS(grade degree,rough,breath,asthenia,strain),and LEMG.Results Among the 38 patients,there were 20 cases in the recurrent laryngeal nerve palsy group and 18 cases in the cricoarytenoid dislocation group.Voice analysis showed that 33 cases had moderate to severe hoarseness(G2~3).Laryngeal three-dimensional CT showed anteromedial or posterolateral dislocation of cricoarytenoid joint.In the group of recurrent laryngeal nerve palsy,13 out of 20 patients underwent LEMG examination,which indicated that the recurrent laryngeal nerve was not completely damaged.The results of 4 patients showed that the recurrent laryngeal nerve was completely damaged.The recruitment potential of cricothyroid muscle was weakened in 3 patients with indicating simultaneous injury of superior laryngeal nerve.LEMG results showed that the dislocation of cricoarytenoid joint was normal in 11 of the 18 patients,and mildly abnormal in 7 of the 18 patients.Among the 20 patients with recurrent laryngeal nerve palsy,16 cases of them had significant improvement in voice quality(G0~1)after medication plus voice training therapy or vocal cord fat injection treatment.The remaining 4 patients without treatment unilaterally relied on the contralateral vocal cord compensation with poor voice recovery(G3).In the group of 18 patients with dislocation of cricoarytenoid joint,they were treated with cricoarytenoid joint reduction and voice training after operation.Satisfactory results were obtained in 17 of 18 cases(G0~1).Conclusion Postoperative VCD is the main cause of hoarseness after surgery.LEMG can make qualitative diagnosis of recurre

关 键 词：喉肌电图 手术 声带运动障碍 

分 类 号：R767.4[医药卫生—耳鼻咽喉科]