声带沟的诊断及治疗

Diagnosis and management of sulcus vocalis

目的 探讨声带沟的分型及治疗方法。方法 2 9例声带沟患者按有无声嘶及沟的形态分为 3型 :Ⅰ型 :生理型 ,11例 (无声嘶 ) ;Ⅱ型 :裂线型 ,13例 ;Ⅲ型 :局凹型 ,5例 ;后两种为病理型声带沟 ,有声嘶。对有声嘶 18例进行了手术及术后嗓音训练治疗 ,手术方法有 :①黏膜下分离自体脂肪注射术 (Ⅱ型 9例 ,Ⅲ型 2例 ,其中 1例为术式②疗效不佳再手术者 ) ;②黏膜切开挖槽自体脂肪注射术(Ⅱ型 4例、Ⅲ型 1例 ) ;③声带沟切除术 (Ⅲ型 4例 ,包括 1例术式①疗效不佳再手术者 )。所有患者均随访 6个月以上 ,平均为 15 3个月。结果 喉镜及嗓音分析发现 ,13例Ⅱ型患者中 10例 (其中 6例为黏膜下分离自体脂肪注射术 ,占该术式 6 /9;4例为黏膜切开挖槽自体脂肪注射术 ,占该术式 4 /4) ,术后 3个月声带沟消失 ,发音良好 ,声带振动恢复 ;另 3例单行黏膜下分离自体脂肪注射术者 ,术后声带沟变浅 ,仍稍声嘶。 5例Ⅲ型患者中 3例行声带沟切除术后 4～ 5个月声带沟消失 ,发音时声门闭合好 ,声带振动恢复 ;另 2例先单行黏膜下分离自体脂肪注射术或黏膜切开挖槽自体脂肪术者 ,术后 10d～ 3个月声带沟再现 ,再次手术后好转。结论 对声带沟患者应分型后采用不同治疗方法 ,黏膜切开挖槽自体脂肪注射术对Ⅱ型治疗效果最好 。

Objective To clarify the pathophysiology of sulcus vocalis and to develop a more rational approach to treatment Methods Twenty nine cases of sulcus vocalis patients were divided into three classification: Type Ⅰ is a physiologic variant and no dysphonia(11 cases) Types Ⅱ(sulcus vergeture, 13 cases) and Ⅲ (sulcus vocalis, 5 cases) are characterized by severe dysphonia and loss of vibratory activity Eighteen cases of dysphonia were treated by surgery and phonation training The operations included fat injection into vocal cords(9 cases of types Ⅱand 1 cases of types Ⅲ,including 1 case of types Ⅲ of second operation), fat implantation into sulcus vergeture after incision(4 cases of types Ⅱand 1 cases of types Ⅲ)and undermining of the mucosa and sulcus vocalis resection(4 cases of types Ⅲ,including 1 case of second operation) Phonatory function and videolaryngostroboscopic data were evaluated before and after surgery and phonation training treatment in 18 patients The mean follow up time was 15 3 months Results Ten cases of types Ⅱ had excellent results after fat injection into vocal cords ( n =6 ) and fat implantation into sulcus vergeture after incision( n =4) Three cases of types Ⅱ improved after fat injection into vocal cords Three cases of type Ⅲ had excellent results after sulcus vocalis resection One case of type Ⅲ had excellent results by Second operation(sulcus vocalis resection) after fat injection into vocal cord One case of type Ⅲ improved by Second operation(fat injection into vocal cords) after fat implantation into sulcus vergeture after incision No postoperative complications were noted Conclusion Accurate classification of sulcus vocalis is important and then adapt treatment to different types Fat implantation into sulcus vergeture to type Ⅱ and sulcus vocalis resection to type Ⅲ were the best choice methods