内镜下CO_(2)激光同期双侧与单侧声带后端切断术治疗双侧声带麻痹的比较研究  

Comparative study on simultaneous bilateral and unilateral posterior vocal cord resection using CO_(2)laser for bilateral vocal cord paralysis

作　　者：彭洁颖 郑宏良 陈世彩 李孟 王伟 江昊 段祥强 张才云 高颖娜 陈梦婕 朱敏辉 Peng Jieying;Zheng Hongliang;Chen Shicai;Li Meng;Wang Wei;Jiang Hao;Duan Xiangqiang;Zhang Caiyun;Gao Yingna;Chen Mengjie;Zhu Minhui(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耳鼻咽喉头颈外科,上海200433

出　　处：《中华耳鼻咽喉头颈外科杂志》2025年第3期338-344,共7页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家自然科学基金(81970868,81600791)。

摘　　要：目的比较内镜下CO_(2)激光同期双侧及单侧声带后端切断术治疗双侧声带麻痹的疗效。方法该病例系列研究回顾性分析了2016年10月至2023年1月在海军军医大学第一附属医院耳鼻咽喉头颈外科收治的双侧声带麻痹且接受内镜下CO_(2)激光声带后端切断术的110例患者资料,男性36例[年龄(45.5±9.1)岁(24~72岁)],女性74例[年龄(47.2±10.1)岁(22~67岁)];接受同期双侧声带后端切断术47例(双侧声带后端切断组),单侧声带后端切断术63例(单侧声带后端切断组)。对比上述2种手术方案治疗前后的患者吞咽功能、声门大小、嗓音功能(主观评估和客观评估)等指标。采用威尔科克森(Wilcoxon)符号秩检验对同组患者手术前后吞咽功能、声门大小、嗓音功能等指标进行分析,用曼-惠特尼(Mann-Whitney)检验分析评估2组患者手术前后各参数的差异。结果术后随访1~5年[中位随访时间1.6(1.3,2.0)年],单侧声带后端切断术组一次手术拔管率为71.4%(45/63),同期双侧声带后端切断术组一次手术拔管率为87.2%(41/47),前者明显低于同期双侧声带后端切断组(χ2=3.94,P<0.05)。术后1周吞咽功能评分单侧声带切断组为2(1,2.5)分,明显低于双侧声带后端切断组的2(1.5,3)分(Z=-2.118,P<0.05),术后3个月2组患者吞咽功能评分均恢复正常。2组患者术前吸气时声门裂隙、听感知评估(GRBAS)、嗓音障碍指数量表(VHI-10)、客观嗓音检测指标的差异均无统计学意义(P值均>0.05)。术后单侧声带后端切断组吸气时声门后连合最大横径为4.49(4.24,4.77)mm,明显小于双侧声带后端切断组的5.05(4.52,5.62)mm(Z=-4.103,P<0.05);GRBAS 5个参数中的G(总嘶哑度)、B(气息声)、A(无力度),以及VHI-10和嗓音功能客观评估指标[频率微扰(jitter)、振幅微扰(shimmer)、谐噪比(HNR)和最长发声时间(MPT)]均明显优于双侧声带后端切断组,差异均具有统计学意义(P均<0.05)。结论对于双侧声带ObjectiveTo compare and analyze the efficacy of bilateral and unilateral posterior vocal cord resection with CO_(2)laser under endoscopy in the treatment of bilateral vocal cord paralysis.MethodsThis case series study retrospectively analyzed the data of 110 patients with bilateral vocal cord paralysis who underwent endoscopic CO_(2)laser posterior cordotomy at the Department of Otolaryngology-Head and Neck Surgery,the First Affiliated Hospital of Naval Medical University,from October 2016 to January 2023.The cohort consisted of 36 males[mean age(45.5±9.1)years,range 24-72 years]and 74 females[mean age(47.2±10.1)years,range 22-67 years].Among them,47 patients underwent simultaneous bilateral posterior cordotomy(bilateral cordotomy group),while 63 patients underwent unilateral posterior cordotomy(unilateral cordotomy group).Pre-and postoperative indicators,including swallowing function,glottal size,and vocal function(subjective and objective assessments),were compared between the two surgical approaches.The Wilcoxon signed-rank test was used to analyze changes in swallowing function,glottal size,and vocal function(subjective and objective assessments)within each group before and after surgery,whereas the Mann-Whitney U test was utilized to assess differences between groups.ResultsPostoperative follow-up was 1-5 years[median follow-up time was 1.6(1.3,2.0)years].The one-time extubation rate was 71.4%(45/63)in the unilateral posterior vocal cord resection group and 87.2%(41/47)in the bilateral posterior vocal cord resection group,significantly higher in the bilateral group(χ2=3.94,P<0.05).One week after surgery,the swallowing function score of unilateral cordotomy group was 2(1,2.5)points,which was significantly better than that of bilateral cordotomy group[2(1.5,3)points,Z=-2.118,P<0.05],and the swallowing function score of both groups returned to normal 3 months after surgery.There were no significant differences in preoperative glottic closure during inhalation,auditory perceptual evaluation(GRBAS),objective v

关 键 词：声带麻痹 声带外移术 拔管率 吞咽功能 嗓音质量 

分 类 号：R767.4[医药卫生—耳鼻咽喉科]