嗓音声学分析在声带息肉术式的选择及治疗中的应用

Application of voice acoustic analysis in selection of surgical procedures for the treatment of vocal cord polyps

目的比较支撑喉镜下喉显微手术与电子纤维喉镜下YAG激光手术治疗不同类型声带息肉的疗效。方法 146例声带息肉患者随机分成两组,其中一组门诊行电子纤维喉镜下YAG激光手术62例,另一组支撑喉镜下显微切除术84例;采用Dr.Speech软件获得两组患者术前1 d、术后1周及术后2周的嗓音基频微扰(jitter)、振幅微扰(shimmer)及嗓音障碍严重指数(dysphonia severity index,DSI)的数值。对嗓音声学参数行统计学分析。结果声带息肉患者术前1 d的基频微扰(jitter)、振幅微扰(shimmer)均高于正常组而DSI偏低,差异均具有统计学意义(P<0.05);两组患者术后1周及术后2周较术前明显好转;电子喉镜下YAG激光手术与支持喉镜下显微手术处理简单型声带息肉,术后同时段比较差异无明显统计学意义(P>0.05);支持喉镜下显微手术处理复杂型声带息肉效果优于电子喉镜下YAG激光手术,同时段比较差异均具有统计学意义(P<0.05);而术后2周与正常对照组比较差异无统计学意义(P>0.05)。结论电子喉镜与支持喉镜处理简单型声带息肉效果相当,处理复杂型声带息肉支持喉镜下显微手术效果更佳。

Objective To compare the therapeutic effects on vocal cord polyps by laryngeal microsurgery under suspension laryngoscope and YAG laser surgery under electrolaryngoscope. Methods Clinical data of 146 cases with vocal cord polyps were analyzed retrospectively. Of them, 84 cases received microsurgery under suspension laryngoscope, and 62 received YAG laser surgery under electrolaryngoscope. Voice acoustic analysis with software Dr. Speech was performed to all the patients one day before operation, one week and 2 weeks after operation respectively. The acoustic parameters including jitter, shimmer and dysphonia severity index （DSI） were recorded and analyzed statistically. Results The preoperative values of jitter and shimmer in vocal cord polyp patients were higher than those the normal group and their DSIs were lower than those of the normal ones. The differences were all statistically significant （ all P 〈 0.05 ）. Compared with the preoperative conditions, all the patients in both groups were improved significantly at one and 2 weeks after operation. For simple vocal cord polyps, the differences of the therapeutic effect over the same time period after operation between the two surgical procedures were statistically insignificant （ all P 〉 0.05 ）. As for complicated vocal cord polyps, the therapeutic effect of microsurgery under suspension laryngoscope was better than that of YAG laser surgery under electrolaryngoscope, and differences over the same time period were statistically significant （ all P 〈 0.05 ）. At 2 weeks after operation, the difference between microsurgery group and normal, and that between YAG laser surgery group andnormal were both statistically insignificant （ both P 〉 0.05 ）. Conclusion Microsurgery under suspension laryngoscope has the same efficacy as YAG laser surgery under electrolaryngoscope for the treatment of simple vocal cord polyp. But for the complicated vocal cord polyp, the effect of microsurgery is better than that of YAG laser surgery.