喉部分切除术后患者的嗓音功能观察

The voice Analysis in Laryngeal Carcinoma Patients Undergoing Partial Laryngectomy

目的研究喉癌患者喉部分切除术后嗓音功能情况及变化趋势,以探讨不同术式与患者术后嗓音质量的关系。方法应用计算机嗓音声学测试系统(Dr.Speech Science for Windows软件,美国泰亿格公司产品)对30例正常对照者及55例喉部分切除术患者(其中喉声门上水平部分切除术组20例,喉垂直部分切除术组18例,喉扩大垂直切除术组17例),于术后5年内不同时间进行嗓音声学测试,并对所测得的平均基频(F0)、基频微扰(jitter)、振幅微扰(shimmer)、标准化噪声能量(NNE)、第一共振峰频率(F1)、第二共振峰频率(F2)进行比较分析。结果三种术式F0均较正常对照组低,jitter、shimmer、NNE均较正常对照组高。jitter、shimmer、NNE数值由低到高排列依次为喉声门上水平部分切除术组、喉扩大垂直切除术组、喉垂直部分切除术组。喉声门上水平部分切除组/a:/、/i:/、/u:/的第一共振峰频率明显高于正常对照组。结论喉水平部分切除术后嗓音功能恢复最佳,而喉垂直部分切除术后最差。嗓音声学分析可作为评价喉癌术后发声质量的定量指标,有助于针对性地指导患者术后嗓音康复训练。

Objective The purpose of this study is to evaluate the relationship between different types of partial laryngectomy and post--operative voice quality by investigating the preserved voice function and its change after the surgery. Methods The computer multimedia program of Dr. Speech science for Windows was used to obtain the acoustic parameters from 30 normal adults and 55 patients operated 5 years ago with partial laryngectomy： 20 cases of horizontal partial laryngectomy, 18 cases of vertical partial laryngectomy, and 17 cases of extended partial laryngectomy. Within 5 years after operation, F0 ,jitter, shimmer, NNE, F, and F2 were measured several times and were compared. Results For the patients the fundamental frequency was lower and jitters, shimmer, NNE were higher compared to the control group. The parameters of jitter, shimmer and NNE of patients with supraglottic horizontal laryngectomy were the lowest while for those with vertical partial laryngectomy they were the highest . Compared were the formant frequencies （F1） of vowels /a ：/,/i：/,/u ： / in group supraglottic horizontal laryngectomy and the normal gruop. The former was significantly higher. Conclusion Close relationships were noted in the different surgery methods and the voice qualities after partial laryngeetomy. The voice functions of horizontal partial laryngecto- my were the best while vertical partial laryngectomy the worst. The acoustic analysis can be used to assess the postoperative voice quality, and the data can guide the rehabilitation and training in terms of the improvement of their quality of life （QOL） after surgery.