CO2激光治疗声带黏膜白色病变的疗效及对嗓音功能的影响分析

Efficacy of CO2 laser microsurgery in the treatment of vocal folds white lesions and its influence on vocal function

目的研究采用显微镜下CO2激光手术治疗声带黏膜白色病变的疗效及对嗓音功能的影响。方法选择38例声带黏膜白色病变患者作为病变组,30例声带正常者作为对照组。病变组患者采用显微镜下CO2激光手术治疗,术前及术后1个月、3个月、6个月、1年分别进行主观和客观嗓音功能评估,复查电子喉镜。观察病变组患者疗效及预后;比较病例组患者手术前后嗓音功能主观评估,两组嗓音功能客观评估。结果术后1周,病例组患者电子喉镜下见声带创面少许伪膜,边缘平整,声带创面光滑平整,声带边缘欠整齐。术后1、3个月,电子喉镜检查显示声带创面愈合良好,声门闭合无明显差异;随访6~28个月,病变组38例患者中,15例治愈,20例好转,总有效率为92.11%;3例复发(7.89%)。术后1、3个月,病例组患者听主观总嘶哑度(G)、粗糙度(R)、气息度(B)、嗓音障碍指数(VHI)评分均低于本组术前,差异具有统计学意义(P<0.05);术后3个月,病例组患者G、R、B、VHI评分均低于本组术后1个月,差异具有统计学意义(P<0.05)。术后1、3个月,病例组患者基频微扰(Jitter)、振幅微扰(Shimmer)、标准化声门噪声能量(NNE)均低于本组术前,最长发生时间(MPT)明显长于本组术前,差异具有统计学意义(P<0.05);术后1、3个月,病例组患者Jitter、Shimmer、NNE、MPT比较差异无统计学意义(P>0.05);术后1、3个月,病例组患者Jitter、Shimmer、NNE、MPT值与对照组比较差异无统计学意义(P>0.05)。结论显微镜下CO2激光手术治疗声带黏膜白色病变具有效性、精准性及安全性好等优势,术后声带黏膜恢复良好,嗓音功能恢复较好,值得临床广泛应用。

Objective To study the efficacy of CO2 laser microsurgery in the treatment of vocal folds white lesions and its influence on vocal function.Methods There were 38 cases of vocal folds white lesions selected as case group,and 30 cases of normal vocal folds as control group.Case group was treated by CO2 laser microsurgery.Before and 1 month,3 months,6 months and 1 year after surgery,the subjective and objective vocal function were evaluated,and was reexamined by the electronic laryngoscope.The efficacy and prognosis of case group was observed.The subjective evaluation of the vocal function of patients in the case group before and after surgery was compared,and the vocal function of the two groups was objectively evaluated.Results 1 week after surgery,patients in the case group showed a little pseudomembrane on the vocal cord wound under the electronic laryngoscope,the edge was flat,the vocal cord wound was smooth and flat,and the vocal cord edge was not neat.1 and 3 months after surgery,the electronic laryngoscopy showed that the wound of vocal cord healed well,and there was no significant difference in glottic closure.38 patients of case group were followed-up for 6-28 months,and 15 cases were cured,20 cases were improved,with total effective rate as 92.11%.3 cases recurred(7.89%).1and 3 months after surgery,the subjective total grade(G),roughness(R),breath(B),and voice handicap index(VHI)score of case group were lower than those before surgery,and the difference was statistically significant(P<0.05).3 months after surgery,G,R,B and VHI score of case group were lower than those 1 month after surgery,and the difference was statistically significant(P<0.05).1 and 3 months after surgery,the fundamental frequency perturbation(Jitter),amplitude perturbation(Shimmer)and normalized noise energy(NNE)of case group were lower than those before surgery,and maximum phonatory time(MPT)was obviously longer than that before surgery,and the difference was statistically significant(P<0.05).In case group,there was no statistically significant in Jitter,Shimmer,NNE and MPT value 1 and 3 months after surgery,compared with those before surgery(P>0.05).1 and 3 months after surgery,Jitter,Shimmer,NNE and MPT value of case group had no statistically significant difference compared with those of the control group(P>0.05).Conclusion Under the microscope,CO2 laser microsurgery has the advantages of effectiveness,accuracy and safety in the treatment of vocal folds white lesions.After surgery,the function of vocal cord mucosa and vocal function recovers well,which is worthy of wide clinical application.