松弛型喉成形术在治疗男声女调中的应用

Relaxation laryngoplasty in the management of mutational falsetto

目的总结松弛型喉成形术治疗男声女调的疗效。方法对经语音矫治失败的30例男声女调患者进行手术治疗，应用并改良甲状软骨成形术Ⅲ型手术，对原法手术中软骨板重叠后缝合固定进行改良，切除软骨条、重叠后不缝合固定为改良1，不切除软骨条、重叠后不缝合固定为改良2。对手术前后患者的基频（fundamentalfrequency，F0）、标准化噪声能量（normalisednoiseenergy，NNE）和朗读短文的语音评价进行比较分析。结果30例患者术前f1D的平均值（孟±s，以下同）为（276．5±46．7）Hz，术后1个月为（127．5±32．1）Hz，术后FO明显降低（t=13．68，P〈0．001）；术前NNE为（-10．9±4．9）dB，术后NNE为（-7．7±4．1）dB，手术前后比较差异有统计学意义（t=4．07，P〈0．001）。三种手术方式中改良1组术后FO下降幅度最大（与原法手术组比较t=2．64，P〈0．05），改良2组术后NNE增加的幅度最小，但与其他两种手术方法比较尚无统计学意义（P〉0．05）。全部病例术后朗读及会话时音调下降，声音翻转消失。结论松弛型喉成形术对治疗男声女调疗效确切，是语音矫治失败后患者的最佳选择。手术方法改良后有利于恢复自然的声调，减轻声门闭合不良造成的术后声嘶。

Objective To observe the result of relaxation laryngoplasty in the management of mutational falsetto. Methods The thyroplasty type 3 was applied and improved （the saturation was improved in the traditional operation, which the thyroid cartilage stick was cut off and overlapped without saturation in improved group 1, while the thyroid cartilage stick was not cut off and overlapped inward without saturation in improved group 2 ） in 30 adult patients who failed in voice modification. Preoperative and postoperative fundamental frequency （170）, normalised noise energy （NNE） and reading essay were compared. Results F0 dropped significantly from the preoperative mean of（ 276. 5 ± 46. 7 ） Hz （ x± s ） to the postoperative mean of （ 127.5 ± 32. 1 ） Hz in one month （ t = 13.68, P 〈 0. 001 ） ,while the NNE dropped significantly from the preoperative mean of（ - 10. 9 ± 4. 9 ） dB to the postoperative mean of （ - 7. 7 ± 4. 1 ） dB ,the difference was statistically significant （ t = 4.07, P 〈 0. 001 ）. In the three kinds of operation, the postoperative F0 in the improved group 1 dropped most significantly （compared with traditional operation group t = 2. 64, P 〈 0. 05 ）. The postoperative NNE in the improved group 2 increasd minimally. The difference was not significant statistically compared with other two kinds of operations （ P 〉 0. 05 ）. The pitch dropped in all cases during reading aloud and conversation, while the voice breaks was disappeared. Conclusions Relaxation laryngoplasty was proved to be an efficient procedure in the surgical management of mutational falsetto. It was a preferable option for the patients who failed in voice modification. The improved operation profitted to recover natural intonation and lighten the hoarseness due to glottie incompetence.