环状软骨上喉部分切除术后新喉形态和发声功能初步研究

Preliminary Study of Laryngeal Morphology and Vocal Function after Supracricoid Partial Laryngectomy

目的探讨环状软骨上喉部分切除术(supracricoid partial laryngectomy,SCPL)后新喉的形态结构和发声功能。方法13例接受SCPL手术的男性喉癌患者年龄47~73岁,平均59±7.7岁,其中行环状软骨舌骨固定术(cricohyoidopexy,CHP)3例、环状软骨舌骨会厌固定术(cricohyoidoepiglottopexy,CHEP)5例、会厌喉成形术(Tucker术式)5例,术后一年进行言语可理解性测试、嗓音主观听感知评估(GRBAS分级,评估总嘶哑度G和气息声B),嗓音声学分析基频(F0)、基频微扰(jitter)、振幅微扰(shimmer)、最长发声时间(MPT)和语谱图评估,并通过频闪喉镜检查新喉的结构和发声运动。结果13例SCPL术后患者新喉喉腔结构变化明显,声门呈倒三角型、弧形、梭形、四边形或不规则形等形状,言语可理解性测试均在7~9.6分之间(I级),其中3例保留单侧杓状软骨的CHP术后患者的总嘶哑度和气息音评估为轻中度,F0在正常男性范围内(分别为127、121、126 Hz),jitter值大于0.5%,而shimmer值在小于3%的正常范围内,语谱图明暗区别较明显、条纹清晰,MPT值接近>15 s的正常值;频闪喉镜下见新声门发声时黏膜振动较对称。而保留单侧或双侧杓状软骨的5例CHEP和5例Tucker术式术后患者,未能测得F0,总嘶哑度和气息音分别为中重度和重度,音域测试仅高频区域有信号,未能记录到jitter及shimmer值,语谱图条纹影不明显,明暗区别不大,无规则乱纹多,MPT值较小,明显低于正常值,频闪喉镜显示发声时喉腔漏气关闭不全,发声时黏膜形成无明显规律的振动或较大幅度抖动。结论不同SCPL术式术后新喉形态结构和发音功能各具特点,言语交流均可被理解,保留单侧环杓单位的CHP手术术后新喉发声时黏膜可形成有效振动声源,而CHEP和Tucker术式术后患者发声时新喉黏膜颤动样或无粘膜运动,发声总嘶哑度和气息音重。

Objective To study the morphology and vocal function of the new larynx after supracricoid partial laryngectomy(SCPL).Methods Thirteen male laryngeal cancer patients(47-73 years old,mean 59±7.7 years)underwent SCPL were included in two study.There were 3 cases of cricohyoidopexy(CHP),5 cases of cricohyoidoepiglottopexy(CHEP)and 5 cases of Tucker’s operation.One year after the operation,speech intelligibility test,hoarseness and breath sound assessment were performed.The fundamental frequency(F0),frequency perturbation(Jitter),amplitude perturbation(Shimmer),maximum vocalization time(MPT)and spectrogram were analyzed,and the new laryngeal structure and vocal movement were examined by videostrobolaryngoscopy.Results The structure of the new larynx was changed obviously in 13 patients after SCPL.The glottis showed inverted triangle,arc,spindle,quadrilateral or irregular shapes.The speech intelligibility test was between 7 and 9.6 points(Grade I).In CHP patients with unilateral arytenoid cartilage preserved,the total hoarseness and breath sounds were assessed as mild to moderate.The Jitter value was greater than 0.5%in the normal male range,while Shimmer value was less than 3%of the normal range.The difference between light and shade was obvious and the stripes were clear in spectrogram and the MPT value was close to the normal value of>15s.Under videostrobolaryngoscopy,the mucosal vibration amplitude of was found in larynx.The degree was similar,and the movement form was more symmetrical.The Grade(G)and Breath(B)of GRBAS evaluation were moderate and severe in CHEP and Tucker’s patients with unilateral or bilateral arytenoid cartilage preservation.In the range test,only the high frequency area had computer recorded signal,but Jitter and Shimmer values were not recorded.There were no obvious striations in spectrogram,irregular lines and small MPT value in spectrogram.There was only irregular mucosal vibration or large amplitude mucosal shaking.Conclusion Different SCPL procedures have their own characteristics of new laryngeal morphology and vocal function,and the speech communication can be understood.The mucosal vibration of CHP with unilateral cricoarytenoid unit has normal voice characteristics and forms effective vibration source.However,patients with CHEP/Tucker’s operation can only have mucosal fibrillation or no mucosal movement,therefore lead to severe total hoarseness and heavy breath.