自体脂肪声带内注射术治疗单侧声带麻痹的远期疗效观察

Long-term follow-up of autogenous fat injection for unilateral vocal ford paralysis

目的 探讨自体脂肪声带内注射术治疗单侧声带麻痹的远期疗效。方法 2 0例单侧声带麻痹患者将取自体腹部的脂肪颗粒注射到麻痹侧声带 ,使声带隆起 ,声门闭合 ,恢复嗓音功能 ;所有病例均随访 12个月以上 ,并按术前及术后即刻、近期 (3～ 6个月 )、远期 (>12个月 )通过电子喉镜以计算机软件测得患侧与健侧声带上表面面积比为参数代表患侧声带大小变化指标 ,并用嗓音疾病评估仪进行嗓音声学测试分析。按术前嗓音声学测试结果分为轻度、中度、重度 3组 ,采用自身对照统计分析结果。结果 注射后麻痹侧声带相应体积较术前明显增大 ,但随时间推移 ,麻痹侧声带内的脂肪部分吸收 ,麻痹侧声带体积逐渐减小 ,而术后近期各组及远期中重度声嘶组测得的麻痹侧声带相应体积与术前差异有显著性 ,轻度声嘶组远期测得的麻痹侧声带相应体积与术前差异无显著性。声学测试客观分析 ,注射后较注射前嘶哑程度明显好转 ,随时间延长嘶哑程度有所下降 ,但术后近期及远期嘶哑程度接近。直接反映声门闭合程度的噪声能量在注射脂肪后较注射前明显下降 ,达到正常或接近正常 ;随时间延长噪声能量稍升高 ,但与术前差异有显著性 ,且术后近期及远期的差异无显著性。结论 自体脂肪声带内注射治疗单侧声带麻痹是可选择的有效方法 。

Objective To study the long term results of autogenous fat injection for unilateral vocal cord paralysis. Methods Twenty cases with unilateral vocal cord paralysis were treated by autogenous fat injection into the thyroarytenoid muscle to achieve medialization. The patients were divided into 3 groups by hoarse degree before operation, all of them were followed more than 12 months with serial video laryngoscope and voice evaluation. The ratio between paralyzed vocal cord upper surface and that of the normal vocal cord were adopted as the measurement for the vocal cord volume changes before and after operation. Results 1. The volume of paralyzed vocal cord was increased . The degree of hoarse and normalized noise energy (NNE) were evaluated by objective methods after operation. 2. The hoarse symptom was less severe after operation than that before operation. The cure cases 3 to 6 months and over 12 months after operation were nearly the same. 3. NNE of over 12 months and 3 to 6 months after operation were not significantly different, but the postoperative NNE were different with that before operation. Conclusions Autologous fat injection was an effective method for treating unilateral vocal cord paralysis, and the long term effects were reliable.