支撑喉镜下显微缝合在声带沟手术中的应用效果分析

Analysis of the effect of microsuture under self-retaining laryngoscope in surgery for sulcus vocalis

目的研究支撑喉镜下显微缝合在声带沟手术中的应用效果。方法将2018年5月~2023年5月自愿接受自体脂肪填充至声带振动边缘治疗,术中应用支撑喉镜下显微缝合的30例声带沟患者作为治疗组;2015年5月~2018年5月经传统手术治疗(发音治疗或对病变声带沟明显增生的瘢痕团块切除、分离黏膜瓣、松解粘连带,术中无显微缝合)的30例声带沟患者作为对照组。比较两组患者声带黏膜恢复程度及发音质量,手术前后喉发声能力视觉模拟评分法(VAS)评分、计算机嗓音分析指标、嗓音障碍指数量表评分。结果治疗组患者声嘶发生率为23.33%,低于对照组的73.33%,差异具有统计学意义(P<0.05)。手术后,两组患者喉发声能力VAS评分较本组手术前降低,且治疗组患者喉发声能力VAS评分(1.72±0.98)分低于对照组的(5.23±1.16)分,差异具有统计学意义(P<0.05)。手术后,两组患者嗓音基频微扰值、振幅微扰值均较本组手术前降低,发音时长较本组手术前延长,且治疗组患者嗓音基频微扰值(0.22±0.08)%、振幅微扰值(1.19±0.48)%低于对照组的(1.17±0.32)%、(5.28±0.69)%,发音时长(17.95±0.99)s长于对照组的(8.89±0.76)s,差异具有统计学意义(P<0.05)。手术后,两组患者嗓音障碍指数量表评分较本组手术前均降低,且治疗组患者嗓音障碍指数量表评分(6.72±0.98)分低于对照组的(13.23±1.16)分,差异具有统计学意义(P<0.05)。结论相对于传统手术治疗方法,支撑喉镜下显微缝合在声带沟手术中应用能够提高声带沟患者的治疗效果,具有较高的临床实践价值,值得推广及应用。

Objective To study the practical effect of microsuture under self-retaining laryngoscope in surgery for sulcus vocalis.Methods 30 patients with sulcus vocalis who voluntarily received autologous fat filling to the vibrating edges of the vocal folds with intraoperative application of microsuture under self-retaining laryngoscope from May 2018 to May 2023 were included as the treatment group.30 patients with sulcus vocalis who underwent conventional surgical treatment(articulation treatment or excision of the scarred mass with significant hyperplasia of the diseased sulcus vocalis,separation of the mucosal flap,and loosening of the adhesive bands without intraoperative microscopic sutures)from May 2015 to May 2018 served as the control group.The vocal fold mucosal recovery and pronunciation quality,visual analog scale(VAS)score of laryngeal vocal ability before and after the surgery,computerized voice analysis index,and voice handicap index score were compared between the two groups.Results The incidence of hoarseness in patients in the treatment group was 23.33%,which was lower than 73.33%in the control group,and the difference was statistically significant(P<0.05).After the surgery,the VAS score of laryngeal vocal ability in the two groups was lower than that before the surgery;the VAS score of laryngeal vocal ability in the treatment group was(1.72±0.98)points,which was lower than(5.23±1.16)points in the control group;the difference was statistically significant(P<0.05).After the surgery,the Jitter value and Shimmer value in both groups were lower than those before the surgery, and the duration of articulation was longer than that before the surgery in both groups;the treatment group had Jitter value of (0.22±0.08)% and Shimmer value of (1.19±0.48)%, which were lower than (1.17±0.32)% and (5.28±0.69)% in the control group;the duration of articulation of (17.95±0.99) s in the treatment group was longer than (8.89±0.76) s in the control group;the difference was statistically significant (P<0.05). After the surgery, the score of voice handicap index in both groups was lower than that before the surgery, and the score of voice handicap index of (6.72±0.98) points in the treatment group was lower than (13.23±1.16) points in the control group. The difference was statistically significant (P<0.05). Conclusion Compared with the traditional surgical treatment, the application of microsuture under the self-retaining laryngoscope in surgery for sulcus vocalis can improve the therapeutic effect of patients with sulcus vocalis, and has high clinical practice value, which is worthy of promotion and application.