CO2激光联合局部注射激素治疗声带粘连的疗效分析

Analysis on Combined Effect of CO2 Laser and Local Injection of Hormone in Treatment of Vocal Cords Adhesion

目的探讨支撑喉镜下CO2激光联合局部注射激素复方倍他米松注射液治疗声带粘连的临床疗效。方法回顾性分析,2014年1月至2018年5月,CO2激光联合局部注射激素治疗的20例声带粘连患者手术前后的动态喉镜及嗓音资料。结果术后随访半年,1例患者再发声带粘连,19例(95%)患者未再发生声带粘连。20例患者术后1、3、6个月嗓音质量的GRBAS主观听感知评估,其中G、R、S三个指标分别与术前比较,差异具有显著意义(P<0. 01)。20例患者术后嗓音质量的客观评价结果如下:嗓音障碍指数(dysphoniaseverityindex,DSI)术后1个月较术前有改变(P<0. 05);术后3、6个月较术前有明显改变(P<0. 01);患者最长发音时间(maximumphonation time,MPT)、振幅微扰(Shimmer)在术后1、3、6个月分别与术前比有,差异具有显著意义(P<0. 01);患者术后6个月的基频微扰(Jitter)较术前比较,差异具有统计学意义(P<0. 05)。结论支撑喉镜下CO2激光分离声带粘连带、并联合声带黏膜下局部注射激素复方倍他米松注射液治疗声带粘连大部分患者可获得良好的疗效。

Objective To investigate the combined clinical effect of CO2 laser separation of vocal cords adhesion assisted with self-retaininglaryngoscope and submucosal injection of hormone betamethasone in treating vocal cords adhesion.Methods The preoperative and postoperative dynamic laryngoscopy and voice data of 20 patients with vocal cords adhesion wereretrospectively analyzed and compared.Results For half a year’s follow-up after the surgery,the results of dynamic laryngoscopy showed that 19(95%)patients had noadhesion of vocal cords and one patient had recurrent vocal cords adhesion. The subjective GRBAS evaluation results of postoperativevoice of the 20 patients showed that the score values of G,R and B 1 month,3 months and 6 months after the surgery weresignificantly different from those before the surgery(P<0. 01). The objective evaluation results of postoperative voice in the 20 patients demonstrated that the DSI of these patients changed only 1 month after the surgery(P<0. 05),which were more significant 3 and 6 months after the surgery(P<0. 01). The MPT and Shimmer of the patients were improved significantly 1 month,3 months and 6 months after the surgery(P<0. 01). The difference between the Jitter result before the surgery and 6 months after the surgery wassignificant(P<0. 05).Conclusions The combination of self-retaining laryngoscope-assisted CO2 laser separation of vocal cords adhesion and submucosalinjection of hormone bethamethasone is rather effective in treating vocal cords adhesion.