内侧微瓣技术治疗声带良性病变手术前后嗓音主客观分析

Subjective and objective evalution for vocal cord benign lesion with medial microflap technique

目的探讨经支撑喉镜显微镜下内侧微瓣技术治疗声带良性病变的手术疗效及嗓音主客观分析在评价其疗效中的作用。方法对34例声带息肉、6例声带囊肿共40例患者行显微嗓音手术内侧微瓣技术切除病变,手术前后分别行动态喉镜检查、嗓音声学检测及嗓音障碍指数量表评估。以20例(男、女各10例)嗓音正常成年人作对照组。结果全组病例术后第4周行动态喉镜检查示声带黏膜光滑,活动好,开闭佳,手术前后各嗓音声学参数及嗓音障碍指数量表评分变化均有统计学意义(P<0.05),声学参数与嗓音障碍指数评分之间无明显相关性。结论内侧微瓣技术治疗局限声带内侧的良性病变具有安全、切除病变精确彻底、创伤小等优点,疗效满意,符合微创和功能外科的发展趋势;嗓音声学检测、动态喉镜检查及患者自我评估三者相结合可对手术疗效起到综合评估作用。

OBJECTIVE To analyze the clinical value of medial microflap technique in phonosurgery under suspension laryngoscope for the treatment of benign vocal cord lesions.METHODS Minimally invasive surgery was performed in 40 patients with benign vocal cord lesions.The medial microflap technique was used during suspension laryngoscope.There were 34 patients with vocal cord polyps and 6 cases with vocal cord cyst.Strobolaryngoscopy,subjective and objective voice analysis were conducted in all the patients before and after operation.In addition,20 normal subjects were also analyzed as control group.RESULTS Four weeks after operation,strobolaryngoscopy showed that the vocal cords of all the patients moved,opened and closed well,and the mucous membrane were smooth.All of the parameters were significantly different before and four weeks after operation（P 〈0.05）.There were no relationship between the acoustic analysis parameters and Voice Handicap Index（V H I）.CONCLUSION Medial microflap technique is a safe,accurate and minimally invasive method for the treatment of benign vocal cord lesion such as vocal cord polyps and vocal cord cyst.The operative outcomes are satisfied and the technique meets the development trend of minimally invasive and functional surgery.Strobolaryngoscopy,acoustic voice analysis and VHI can assess the operative efficacy comprehensively.