支撑喉镜辅助等离子手术对声带息肉患者嗓音质量、疼痛介质及预后的影响

Effects of Plasma Surgery Assisted by Self-retaining Laryngoscope on Voice Quality,Pain Mediators and Prognoses of Patients with Vocal Cord Polyps

目的探讨支撑喉镜辅助等离子手术治疗声带息肉的效果及对患者嗓音质量、疼痛介质及预后的影响。方法选取2016年1月—2019年12月我院收治的声带息肉82例,根据手术方式不同分为等离子组42例和显微组40例。等离子组采取支撑喉镜辅助等离子手术,显微组采取支撑喉镜下显微切除术。比较2组手术相关指标、术后2周临床疗效及术后6、12个月复发率情况。比较2组围术期疼痛介质[前列环素(PGI 2)、β-内啡肽(β-EP)、神经肽Y(NPY)]水平、视觉模拟评分(VAS)、嗓音质量指标[基频微扰(Jitter)、噪声能量(NNE)、振幅微扰(shimmer)、谐噪比(HNR)]水平。结果等离子组手术时间、首次发声时间、住院时间、嗓音恢复时间均短于显微组(P<0.01)。与术前比较,2组术后1、3 d血清PGI 2、β-EP、NPY水平均提高,且等离子组上述指标均低于显微组,差异有统计学意义(P<0.01)。等离子组术后6 h、1、2、3 d的VAS评分均低于显微组(P<0.01)。与术前比较,2组术后1、2周Jitter、NNE、shimmer水平降低,HNR水平升高,且等离子组上述指标变化较显微组更显著(P<0.01)。与显微组比较,等离子组术后2周总有效率增高,术后1年复发率减低(P<0.05)。结论支撑喉镜辅助等离子手术治疗声带息肉,具有创伤小、手术时间短、术后恢复快等优势;可减轻术后疼痛,降低疼痛介质水平,改善客观发声功能,降低术后复发率。

Objective To investigate efficacy of plasma surgery assisted by self-retaining laryngoscope in treatment of patients with vocal cord polyps and its effects on voice quality,pain mediators and prognoses of patients.Methods A total of 82 patients with vocal cord polyps admitted during January 2016 and December 2019 were selected and divided into plasma group(n=42)and microsurgery group(n=40)according to different surgical methods.Plasma group was treated with self-retaining laryngoscope assisted plasma surgery,while microsurgery group was treated with self-retaining laryngoscope assisted microsurgery.Levels of related surgical indicators,clinical efficacy after operation for 2 weeks,and recurrence rates in the 6 th and 12 th months after operation were compared in two groups,Perioperative levels of pain mediators[prostacyclin(PGI 2),β-endorphin(β-EP),neuropeptide Y(NPY)],visual analogue scale(VAS)score,and levels of voice quality indicators[Jitter,normalized noise energy(NNE),Shimmer,Harmonic to noise ratio(HNR)]were compared between two groups.Results Operative duration,first vocalization time,length of hospitalization and time of voice recovery in plasma group were all shorter than those in microsurgery group(P<0.01).On the 1 st and 3 rd after surgery,serum levels of PGI 2,β-EP and NPY were significantly higher than those before operation in two groups,and levels of the above indicators in plasma group were significantly lower than those in microsurgery group(P<0.01).VAS scores on the 6 th h,1 st d,2 nd d and 3 rd d after operation in plasma group were significantly lower than those in microsurgery group(P<0.05).In the 1 st and 2 nd weeks after surgery,Jitter,NNE and Shimmer levels were significantly decreased,while HNR levels were increased compared with those before operation in two groups,and changes in the above indicators in plasma group were more significant than those in microsurgery group(P<0.05).Compared with those in microsurgery group,the total effective rate in the 2 nd weeks after surgery was significantly increased,while recurrence rate in the 1 st year after operation was significantly decreased in plasma group(P<0.05).Conclusion Plasma surgery assisted by self-retaining laryngoscope in treatment of patients with vocal cord polyps has advantages such as less trauma,short duration of operation and quickly postoperative recovery.In addition,it may reduce degree of postoperative pain and levels of pain mediators,improve objective vocal function and decrease postoperative recurrence rate.