纤维喉镜下声带息肉切除术与支撑喉镜下显微手术治疗声带息肉的疗效对比

Comparison of efficacy of vocal cord polypectomy under fibrolaryngoscope and microsurgery under suspension laryngoscope in the treatment of vocal cord polyps

目的探讨纤维喉镜下声带息肉切除术与支撑喉镜下显微手术治疗声带息肉的疗效。方法选取2016年1月至2018年1月本院收治的72例声带息肉患者为研究对象,采用随机数表法将其分为观察组和对照组,每组各36例。对照组患者行纤维喉镜下声带息肉切除术治疗,观察组患者行支撑喉镜下显微手术治疗。比较两组患者手术及康复指标(手术时间、术中出血量、首次发声时间、声音恢复时间、住院天数)、手术疗效、治疗前后嗓音学指标[基频微扰、振幅微扰、声门噪声能量(normalized noise energy,NNE)]、术后1 d创伤相关指标[热休克蛋白72(heat shock protein 72,HSP72)、高迁移率族蛋白B-1(high mobility group box-1,HMGB-1)、前列环素(prostacyclin,PGI2)、β-内啡肽(β-endorphin,β-EP)、神经肽Y(neuropeptide Y,NPY)]。结果观察组患者手术时间、首次发声时间、声音恢复时间均显著短于对照组(P_均<0.05),术中出血量显著少于对照组(P <0.05),治疗总有效率显著高于对照组(P <0.05),住院天数组间比较无显著差异(P> 0.05);术后4周,两组患者基频微扰、振幅微扰、NNE均较术前降低(P_均<0.05),且观察组患者上述指标均显著低于对照组(P_均<0.05);术后1 d,观察组患者血清HSP72、HMGB-1、PGI2、β-EP、NPY水平均明显低于对照组(P_均<0.05)。结论与纤维喉镜下声带息肉切除术比较,支撑喉镜下显微手术治疗声带息肉的效果更佳,能有效促进嗓音功能恢复,缩短手术和术后恢复时间,手术创伤小,术后疼痛轻。

Objective To investigate the efficacy of vocal cord polypectomy under fibrolaryngoscope and microsurgery under suspension laryngoscope in the treatment of vocal cord polyps.Method 72 patients with vocal cord polyps admitted to our hospital from January 2016 to January 2018 were selected as the research objects.The patients were divided into observation group and control group by random number table method,36 cases in each group.Patients in control group were treated with fibrolaryngoscope for vocal cord polypectomy,while patients in observation group were treated with supportive laryngoscope for microsurgery.The surgical and rehabilitation indexes(operation time,intraoperative blood loss,first phonation time,sound recovery time,hospital stay),surgical efficacy,vocal parameters before and after treatment [jitter,shimmer,normalized noise energy(NNE)],and trauma parameters one day after operation [heat shock protein 72(HSP72),high mobility group box-1(HMGB-1),prostacyclin(PGI2),β-endorphin(β-EP),neuropeptide Y(NPY)] were compared between the two groups.Result The operation time,first phonation time and sound recovery time in observation group were all shorter than those in control group(Pall<0.05),and the intraoperative blood loss was lower than that in control group(P<0.05),while the total effective rate of treatment was higher than that in control group(P<0.05),the hospital stay between the two groups had no significant difference(P>0.05).At 4 weeks after operation,the levels of jitter,shimmer and NNE in the two groups were lower than those before operation(Pall<0.05),and the levels in observation group were lower than those in control group(Pall<0.05).At one day after operation,the serum levels of HSP72,HMGB-1,PGI2,β-EP and NPY in observation group were significantly lower than those in control group(Pall<0.05).Conclusion Compared with vocal cord polypectomy under fibrolaryngoscope,microsurgery under suspension laryngoscope has better effects on vocal cord polyps,and it can effectively promote the recovery of voice function,and shorten the operation time and postoperative recovery time,and it also can reduce the surgical trauma and the postoperative pain.