喉裂开声带切除术对喉低分化鳞状细胞癌患者吞咽及语音功能的影响

Effects of Laryngofissure Cordectomy on Swallowing and Speech Function in Patients with Poorly Differentiated Squamous Cell Carcinoma of Larynx

目的探讨喉裂开声带切除术对喉低分化鳞状细胞癌患者吞咽及语音功能的影响。方法将河北北方学院附属第一医院2018年2月至2019年5月采用喉扩大部分切除术治疗的44例喉低分化鳞状细胞癌患者作为对照组,2019年6月至2020年7月采用喉裂开声带切除术治疗的50例喉低分化鳞状细胞癌患者作为研究组,比较两组术后2周吞咽功能、发音功能。随访1年,记录两组患者拔管时间及拔管率,并采用Dr.Speech软件检测患者嗓音声学指标。结果研究组术后吞咽功能0级占比、发音功能改善有效率、拔管率均高于对照组[82.00%(41/50)比61.36%(27/44)、92.0%(46/50)比68.2%(30/44)、92.00%(46/50)比75.00%(33/44)](P<0.05),且研究组术后吞咽功能、发音功能均优于对照组(P<0.05),拔管时间早于对照组(Z=6.684,P=0.035)。两组末次随访时基频、基频微扰、振幅微扰、标准化噪声能量均高于术前(P<0.05)。末次随访时,研究组基频微扰、振幅微扰、标准化噪声能量均高于对照组[(1.35±0.31)%比(1.01±0.25)%、(6.31±0.84)%比(4.02±0.57)%、(-3.05±0.33)dB比(-4.96±0.25)dB](P<0.01),但两组基频比较差异无统计学意义(P>0.05)。结论喉裂开声带切除术可有效改善喉低分化鳞状细胞癌患者吞咽及发音功能,且术后拔管率高,对患者远期语音功能恢复具有良好促进作用。

Objective To investigate the effect of laryngofissure cordectomy on swallowing and speech function in patients with poorly differentiated squamous cell carcinoma of the larynx.Methods A total of 44 patients with poorly differentiated squamous cell carcinoma of the larynx who were treated with extended partial laryngectomy in the First Affiliated Hospital of Hebei North University from Feb.2018 to May 2019 were included as a control group,50 patients with poorly differentiated squamous cell carcinoma of the larynx treated with laryngofissure cordectomy from Jun.2019 to Jul.2020 were included as a study group.The swallowing function and pronunciation function were compared between the two groups at 2 weeks postoperatively.Follow up was done for 1 year,the extubation time and extubation rate of the two groups were recorded,and Dr.Speech software was used to detect the voice acoustic indicators of the patients.Results The proportion of grade 0 swallowing function,effective rate of improvement of articulation function and extubation rate in the study group were higher than those in the control group[82.00%(41/50)vs 61.36%(27/44),92.0%(46/50)vs 68.2%(30/44),92.00%(46/50)vs 75.00%(33/44)](P<0.05),the swallowing and articulation functions of the study group were better than those of the control group(P<0.05),and the extubation time was earlier than that of the control group(Z=6.684,P=0.035).The fundamental frequency,fundamental frequency perturbation,amplitude perturbation and standardized noise energy were all higher in both groups at the last follow-up than before surgery(P<0.05).At the last follow-up,the fundamental frequency perturbation,amplitude perturbation and standardized noise energy of the study group were higher than those of the control group[(1.35±0.31)%vs(1.01±0.25)%,(6.31±0.84)%vs(4.02±0.57)%,(-3.05±0.33)dB vs(-4.96±0.25)dB](P<0.01),but there was no significant difference in fundamental frequency between the two groups(P>0.05).Conclusion Laryngofissure cordectomy can effectively improve the swallowing function and articulation function of patients with poorly differentiated squamous cell carcinoma of larynx,and the postoperative extubation rate is high,which has a good promoting effect on the long-term recovery of voice function of the patients.