特发性声带麻痹患者环杓后肌肌纤维形态观察

The Morphology Observation of Posterior Cricoarytenoid Muscle Myofiber in Patients with Idiopathic Vocal Fold Paralysis

目的探讨特发性声带麻痹患者环杓后肌肌纤维形态变化规律,为其治疗方法的选择提供依据。方法 39例声带麻痹患者分成特发性声带麻痹组（特发组,n=16）及创伤性声带麻痹组（创伤组,n=23）,二组根据病程再分别分为三个亚组：0.5~1年组（分别为5例及7例）、〉1~2年组（分别为5例及10例）、〉2年组（分别为6例及6例）,分别取各组患侧的部分环杓后肌;另取5例正常人环杓后肌为正常对照组;行masson三色染色法染色,Image Pro Plus图像分析系统分析环杓后肌相对肌肉截面积和胶原相对截面积的变化,并比较各组间的差异。结果随着病程延长,特发性声带麻痹组环杓后肌的肌纤维细胞逐渐萎缩,截面积减小,胶原纤维细胞逐渐增加,胶原纤维截面积增加;肌肉截面积/胶原截面积比率逐渐下降,以0.5~1年组的截面积比下降最为明显;各亚组环杓后肌相对截面积较对照组明显减小（P〈0.05）,胶原相对截面积较正常对照组明显增大（P〈0.05）;〉2年组和〉1~2年组之间比较差异无统计意义（P〉0.05）。特发组与创伤组相同时间段亚组环杓后肌和胶原纤维截面积分别两两比较差异均无统计学意义（均为P〉0.05）。特发组有的病例尽管病程长达10年,但环杓后肌萎缩纤维化并不严重,而有的病例虽然病程仅1.5年,但肌肉萎缩却非常明显,存在较大个体差异。结论特发性声带麻痹患者病程半年以上者,环杓后肌肌肉截面积与胶原截面积比下降明显,故对于保守治疗半年以上声嘶无改善者,可考虑尽快行喉返神经修复术（1年内）;对于病程较长者（〉2年）,部分病例可能仍存在进行神经修复的肌肉形态学基础。

Objective To investigate the morphology change of posterior cricoarytenoid muscle myofiber in patients with idiopathic vocal fold paralysis and to provide experimental evidence for the clinical treatment of idio‐pathic vocal cord paralysis .Methods Thirty -nine cases of vocal fold paralysis patients were recruited into and di‐vided into 2 groups ：idiopathic vocal cord paralysis group（n=16） ,and traumatic vocal cord paralysis group（n=23） . Both groups were further divided into 3 subgroups：0 .5~1 year（5 cases and 7 cases） ,〉1~2 years（5 cases and 10 cases） ,〉2 years（6 cases and 6 cases） .Part of posterior cricoarytenoid muscle（PCAM ） were acquired from all of vo‐cal cord paralysis patients .Normal human posterior cricoarytenoid muscles were treated as the control group （n=5） . They were all stained with Masson three-color staining ,the fiber crosssectional area of muscle tissue and collagen connective tissue were quantitatively analyzed with the image pro plus analysis system .Differences of two observa‐tion indexes were compared with each other among groups and subgroups .Results The number of myofibers was decreased ,but the numbers of the collagen fibers was increased with the onset time course extension ,the ratio of cross sectional area of myofibers to those of collagen fibers was progressively decreasd with increased time course of denervation and more decrease within 1 year .There was obvious difference between the control group and 0 .5~1 year ,〉1~2 years ,〉2 years subgroup of idiopathic vocal cord paralysis （P〈0 .05） .Although without no signifi‐cant difference between 〉1~2 years subgroup and 〉2 years subgroup ,the trend of shrinking still existed .Com‐pared two observation indexes of traumatic vocal cord paralysis with the same period subgroup indexes of idiopathic vocal fold paralysis ,there was no significant difference about these two observation indexes （P〉0 .05） .In some special cases with 10 years duration in idiopathic vocal cord paralysis group ,the posterior cricoarytenoid muscle at‐rophy fibrosis was not serious .However ,in some case which the course lasted for only 1 .5 years ,the muscle atrophy was very obvious .There were great individual differences among idiopathic vocal cord paralysis patients .Conclusion If there is no recovery after half year treatment ,for PCA muscle function recovery ,the recurrent laryngeal nerve injury repair surgery could be considered to carry out within 1 year .In some cases with long disease duration （〉2 years） ,they may still have the muscle morphological basis for nerve repair .