前联合切除对喉癌患者二氧化碳激光切除术后嗓音功能影响

Effect of anterior commissure excision on voice function in patients with laryngeal carcinoma after carbon dioxide laser excision

目的探讨二氧化碳(CO_2)激光切除喉癌患者前联合对其嗓音功能的影响。方法选取2017年1—12月接受CO_2激光手术治疗的喉癌患者25例为研究对象。按术中是否切除前联合分为未切除组(n=14)与切除组(n=11),另选择30例健康男性作为健康对照组。于术后6个月对两组患者进行嗓音客观评估,包括嗓音声学分析、电声门图检查、最长发声时间测定、频闪喉镜检查,并对患者进行嗓音障碍指数-10(VHI-10)评分。结果切除组及未切除组各参数与健康对照组比较,差异均有统计学意义(P <0. 05)。切除组振幅微扰、标准化噪声能量值高于未切除组,接触商、最长发声时间低于未切除组,两组比较,差异均有统计学意义(P <0. 05)。切除组与未切除组患者VHI-10得分大部分处于中、重度嗓音障碍,所占比例分别为90. 9%(10/11)、85. 7%(12/14)。结论喉前联合是否切除对CO_2激光术后嗓音功能的恢复有一定影响,术中应尽量保留前联合或避免损伤,术后可获得更好的发声质量。

Objective To investigate the effect of carbon dioxide( CO2) laser excision on voice function in laryngeal cancer patients.Methods A retrospective study was performed on 25 cases of patients with laryngeal cancer who were admitted from January to December 2017. The patients were divided into the unresected group( n = 14) and the resected group( n = 11) according to whether the surgery was performed before resection or not,and 30 healthy men were selected as the healthy control group. Objective evaluation of voice was performed 6 months after surgery in both groups,including voice acoustic analysis,electro-glottogram examination,measurement of maximum vocalization time,stroboscopic laryngoscopy,and voice impairment index-10( VHI-10) score. Results The parameters of the resected group and the unresected group were significantly different from those of the healthy control group( P < 0. 05). The shimmer and normalized noise energy values of the resected group were higher than those of the unresected group,and the contactquotient and maximum phonation time values were lower than those of the unresected group( P < 0. 05). The VHI-10 scores of patients in the resected group and the unresected group were mostly in moderate and severe voice disorders,accounting for 90. 9%( 10/11) and85. 7%( 12/14),respectively. Conclusion Voice recovery and savings after CO2 laser surgery was closely related with the anterior commissure excising or not. Avoid injuring or retain anterior-commissure could get a better vocal function.