自体筋膜加脂肪声带注射术治疗声门闭合不全的疗效观察

Vocal fold augmentation by injection of autologous fascia and fat

目的 探讨自体筋膜加脂肪声带注射术治疗声门闭合不全的疗效.方法 对26例单 侧声带麻痹声门闭合不全患者全麻支撑喉镜下经口行声带内注射术,其中6例采用自体脂肪注射（A组）,20例采用自体腹直肌前鞘筋膜加脂肪注射（B组）.术前、术后动态喉镜检查和主客观嗓音分析评估疗效,均随访24个月.结果 两组患者术后注射物无外溢,注射侧声带形态饱满;术后3 d注射侧声带出现急性炎性反应,3个月左右消退.术后3个月A组所有患者注射侧声带回复至中线,声门闭合良好,6～24个月声门闭合稍有缝隙;B组所有患者术后6个月回复至中线,声门闭合良好,6～24个月声带形态稳定.术前嗓音声学分析：两组间基频微扰、振幅微扰、标准化噪声能量及最大发音时间差异无统计学意义（P值均＞0.05）;A组术后3个月显著改善（P值均＜0.01）,6及24个月较术前改善（P值＜0.05或＜0.01）,但较术后3个月音质下降（P值＜0.05或＜0.01）;B组术后6个月显著改善（P值均＜0.01）,6、12及24个月各参数差异均无统计学意义（P值均＞0.05）;术后24个月两组的基频微扰、标准化噪声能量及最大发音时间差异有统计学意义（P值＜0.05或＜0.01）.B组嗓音听感知评估,总嘶哑度、气息声、发音无力程度评分降低,与术前相比差异有统计学意义（P值均＜0.01）.结论 自体腹直肌前鞘筋膜加脂肪声带内注射术治疗单侧声带麻痹声门闭合不全可有效提高患者声音质量,远期效果稳定.

Objective To evaluate the effect of combination of autologous fascia and fat injection into vocal fold for the treatment of patients with unilateral vocal fold paralysis and to observe the long-term effectiveness of this procedure. Methods A total of 26 unilateral vocal fold paralysis patients underwent vocal fold injection under general anesthesia, meanwhile, the mucosa of the injected point was sutured through laryngoscope under direct vision. There were 6 patients underwent autologous fat injection into vocal fold （ group A）, and 20 patients underwent autologous anterior rectus sheath fascia and fat injection （ group B）. Therapeutic efficacy were evaluated by videostroboscopy, voice-related parameters analysis and voice evaluation before and after treatment. Clinical analysis of this procedure was retrospectively performed in this serial of patients. Results All patients were followed up for 24 months. On the third day after operation,there was an acute inflammatory reaction induced by the graft. This reaction disappeared three months later.In all 20 eases, videolaryngostroboscopy showed significant improvement of the glottic closure, the improvement in acoustical parameters was statistically significant （ P ＜ 0. 01 ）. Perceptual evaluation of GRBAS scale showed significant improvement of phonatory function on G, B, A scale. The results remained stable 6 -24 months after operation and were not changed by the length of follow-up. And in the 6 cases,videolaryngostroboscopy showed significant improvement of the glottic closure at 3 months compared with preoperative observation, a little spindle-shaped disclosure. The improvement in acoustical parameters was significant statistically at 3, 6 and 24 months （P ＜ 0. 05 or ＜ 0. 01 ）, the voice quality decreased significantly at 6 and 24 months compared with 3 months （P ＜0. 05 or ＜0. 0l ）. The significant differences were not observed between 6 and 24 months （P ＞ 0. 05 ）. No complications were observed in all patients perioperatively or during the follow-up period. Voice-related parameters jitter, normalized noise energy and maximum phonation time showed significant differences between Group A and Group B on 24 months （ P ＜0. 05 or ＜ 0. 01 ）. Conclusion The combination of autologous fascia and fat vocal fold injection is an effective procedure for the treatment of unilateral vocal fold paralysis, and the stable results can be achieved during the follow-up period for 24 months.