胸骨舌骨肌内翻喉功能重建术对声门型喉癌的疗效分析

Effect of laryngeal function reconstruction of sternohyoid muscle inversion for treatment of glottic carcinoma

目的 观察胸骨舌骨肌内翻喉功能重建术对声门型喉癌的疗效。方法 选择2020年1月—2023年12月本院耳鼻咽喉科收治的106例声门型喉癌患者为研究对象,将其随机分成对照组与观察组,每组53例。对照组行垂直部分喉切除术,观察组行垂直部分喉切除术联合胸骨舌骨肌内翻喉功能重建术。观察2组嗓音学指标[标准化噪声能量(NNE)、谐噪比(HNR)、基频微扰(Jitter)、振幅微扰(Shimmer)]、吞咽功能[电视透视吞咽功能检查(VFSS)评分]、生活质量[嗓音障碍指数(VHI)评分]、发音功能改善情况以及并发症(刺激性咳嗽、咽痛、呼吸困难、喉狭窄、局部粘连)发生情况。结果 2组术后3个月的NNE、Jitter、Shimmer均较术前下降,HNR提高,差异有统计学意义(P<0.05);观察组术后3个月的NNE、Jitter、Shimmer低于对照组,HNR高于对照组,差异有统计学意义(P<0.05)。2组术后3个月VFSS评分较术前提高,VHI评分较术前降低,差异有统计学意义(P<0.05);观察组术后3个月的VFSS评分高于对照组,VHI评分低于对照组,差异有统计学意义(P<0.05)。对照组发音功能改善效果优良率为71.70%,低于观察组的88.68%,差异有统计学意义(P<0.05)。观察组并发症发生率为9.43%,低于对照组的24.53%,差异有统计学意义(P<0.05)。结论 垂直部分喉切除术联合胸骨舌骨肌内翻喉功能重建术治疗声门型喉癌,可有效改善患者嗓音学指标、吞咽功能、生活质量以及发音功能,且并发症发生率较低。

Objective To observe effect of laryngeal function reconstruction of sternohyoid muscle inversion for treatment of glottic carcinoma.Methods A total of 106 patients with glottic carcinoma admitted to the Department of Otolaryngology in our hospital from January 2020 to December 2023were selected and randomly divided into control group and observation group,with 53 patients in each group.The control group underwent vertical partial laryngectomy,while the observation group received vertical partial laryngectomy combined with thyrohyoid muscle inversion laryngeal reconstruction.Both groups were assessed for voice-related parameters [normalized noise energy(NNE),harmonic-to-noise ratio(HNR),jitter,shimmer],swallowing function [videofluoroscopic swallowing study(VFSS) score],quality of life[voice handicap index(VHI) score],improvement in phonation function,and incidence of complications(irritative cough,pharyngeal pain,dyspnea,laryngeal stenosis,local adhesion).Results Three months postoperatively,both groups showed significant decrease in NNE,jitter,and shimmer,and an increase in HNR compared to preoperative levels(P <0.05).The observation group demonstrated lower NNE,jitter,and shimmer,and higher HNR than the control group at 3 months postoperatively(P <0.05).Both groups had improved VFSS scores and reduced VHI scores at 3 months compared to preoperation(P <0.05).The observation group showed higher VFSS scores and lower VHI scores than the control group at 3 months after operation(P <0.05).The control group achieved an excellent or good rate of phonation function improvement was significantly lower than the observation group(88.68% versus 71.70%,P <0.05).The incidence of complications in the observation group was significantly lower than that in the control group(9.43% versus 24.53%,P <0.05).Conclusion The combination of vertical partial laryngectomy and laryngeal function reconstruction of sternohyoid muscle inversion for glottic carcinoma effectively improves voice-related parameters,swallowing function,quality of life,and phonation function,with a lower incidence of complications.