声带纤维囊样变治疗疗效分析

Analysis of therapeutic effect of fibrocystic degeneration of vocal folds

目的:探索声带纤维囊样变与声带息肉、声带囊肿等其他常见声带良性病变的临床表现与治疗疗效的差异。方法:对在厦门大学附属中山医院嗓音科接受手术治疗的10例声带纤维囊样变、30例声带息肉及10例声带囊肿患者进行术前和术后的嗓音功能评估。嗓音功能评估的检查包括GRBAS(G分级)、嗓音障碍指数-10(VHI-10)量表、反流症状指数(RSI)量表、频闪喉镜、声学客观分析及喉空气动力学检查。声学客观分析选取的参数包括基频(F0)、基频微扰(Jitter)、振幅微扰(Shimmer)以及嗓音障碍严重程度指数(DSI),喉空气动力学检查主要收集最大发声时(MPT)。频闪喉镜选取的参数包括声带平直度、声带颜色、声门闭合程度以及黏膜波情况。3组患者均接受了嗓音显微黏膜微瓣手术。术后1个月进行门诊复查。比较3组患者术前与术后嗓音功能评估参数的差异。结果:术前声带纤维囊样变组与声带息肉组、声带囊肿组的G分级、Jitter、Shimmer、DSI、声门闭合情况、黏膜波比较差异有统计学意义(P<0.05)。术后3组的大部分嗓音评估功能参数较术前均有显著改善(P<0.05)。术后声带纤维囊样变组的VHI-10、RSI、黏膜波评分改善情况与声带息肉组比较差异有统计学意义(P<0.05)。结论:声带纤维囊样变的病情较声带息肉、声带囊肿这两类常见的声带良性增生性病变的病情严重,嗓音显微微瓣手术是治疗声带纤维囊样变的有效方法,但其疗效差于声带息肉和声带囊肿的治疗效果。因此,术前进行精细的评估对于预测手术疗效至关重要。

Objective To explore the differences in clinical presentation and therapeutic outcomes between vocal fold fibrocystic degeneration and other common benign lesions,such as vocal fold polyp and cyst.Methods Vocal function was assessed before and after surgery in 10 cases of vocal fold fibrocystoids,30 cases of vocal fold polyps and 10 cases of vocal fold cysts at Department of Voice Medicine,Xiamen University Zhongshan Hospital.The voice Assessments included GRBAS(G-scale),VHI-10 scale,Reflux Symptom Index(RSI)scale,stroboscope,acoustic objective analysis,and aerodynamics measurements.The acoustice analysis parameters included fundamental frequency(F0),fundamental frequency perturbation(Jitter),amplitude perturbation(Shimmer)and voice disturbance severity index(DSI),while the maximum phonation time(MPT)was assessed for aerodynamics.Stroboscopic parameters included vocal fold straightness,vocal fold color,glottic closure and mucosal wave.All three groups underwent phonomicrosurgery and a follow-up review was conducted one month later.Pre-and post-operative function assessment parameters were compared across the three groups.Results Significant differences were founded in the G grade,Jitter,Shimmer,DSI,glottic closure and mucosal wave between the vocal fold fibrocystic degeneration group and the vocal fold polyp and vocal fold cyst group(P<0.05).Most voice function parameters in all three groups showed significant improvement after surgery(P<0.05).The improvement of VHI(10),RSI and mucosal wave scores in the vocal fold fibrocystic lesion group was significantly different from that of the vocal fold polyp group(P<0.05).Conclusion Vocal fold fibrocystic degeneration is a more severe than that of vocal fold polyps and cysts,which are two common benign vocal fold lesions.Phonomicrosurgery is an effective treatment for vocal fold fibrocystic degeneration,but its curative effect are less favorable compared to those for vocal fold polyps and vocal fold cysts.Therefore,a detailed preoperative evaluation is essential for predicting surgical outcomes.