摘要
目的评价一侧膈神经上根联合舌下神经甲舌肌支选择性喉返神经修复术(以下简称选择性喉返神经修复术)对双侧声带麻痹患者气道和嗓音质量的改善作用。方法对2012年1月至2016年12月,在海军军医大学第一附属医院耳鼻咽喉头颈外科行选择性喉返神经修复术的39例资料完整的双侧声带麻痹患者的病例资料行回顾性研究。所有患者术前术后均行频闪喉镜、嗓音主观评估、声学参数、喉肌电图及肺功能检查,并进行至少2年随访,评价疗效及安全性。声音总嘶哑度评分及VHI-10评分数据采用Wilcoxon符号秩检验进行统计分析,声学参数[包括基频微扰(Jitter)、振幅微扰(Shimmer)、噪谐比(NHR)]、最长发声时间(MPT)值和肺功能参数数据采用配对t检验进行统计分析。结果39例患者中,术后发生感染及出血各1例。术后4~8个月,所有患者发音时声带均可内收,35例患者吸气时声带达到中、重度的外展运动,2例始终仅轻度外展,2例无外展运动,中度以上运动幅度的恢复率达89.7%(35/39),并顺利拔管,随访2年无变化。术后12个月时嗓音总嘶哑度G及VHI-10评分较术前均明显降低(P值均<0.05),声学参数Jitter、Shimmer、NHR及MPT较术前均明显改善,差异均有统计学意义(P值均<0.05)。术后3个月,患者肺功能大部分参数恢复到正常参考值水平,术后12个月最大吸气压力(PImax)值仍略低于正常水平,但与术前相比均有显著改善(P值均<0.05)。术后12个月时患者肌电图资料显示,37例患者吸气时双侧环杓后肌均呈干扰相电位,发音时双侧甲杓肌亦为干扰相电位,其中2例还存在明显错向电位。2例外展功能恢复不佳者环杓后肌电位明显较弱。长期随访仅1例外展运动幅度减弱,但不影响呼吸功能。结论本研究采用选择性喉返神经修复术治疗双侧声带麻痹,恢复生理性声带外展内收运动的成功率高、疗效稳定、并发症少,值得�
Objective To evaluate the airway and voice quality improvement in patients with bilateral vocal fold paralysis(BVFP)who underwent selective laryngeal reinnervation surgery.Methods From January 2012 to December 2016,a retrospective study was conducted in 39 patients with BVFP who underwent selective laryngeal reinnervation surgery in Department of Otorhinolaryngology Head and Neck Surgery,the First Affiliated Hospital of Navy Medical University.All patients were examined by videostroboscopy,vocal function assessment,laryngeal electromyography and pulmonary function test before and after the surgery,and followed up for at least 2 years to evaluate the efficacy and safety of the surgery.Wilcoxon signed rank test was used to analyze the G score and VHI-10 score data.Paired t-test was used to analyze acoustic parameters,MPT values and pulmonary function parameters.Results Postoperative infection and hemorrhage occurred in one patient separately.Videostroboscopic videos showed that at 4-8 months postoperatively,vocal folds in 35 patients achieved moderate or severe abduction during inspiration,2 patients only achieved mild abduction,2 patients showed no abduction,while all patients achieved adduction in bilateral vocal cords during phonation.The recovery rate of moderate-to-severe abduction was 89.7%(35/39),and these patients were decannulated successfully.At 12 months after operation,G score and VHI-10 score were significantly lower than those before operation(P<0.05),and the acoustic parameters jitter,shimmer,HNR and MPT were significantly improved(P<0.05).Most of the parameters of the pulmonary function test at 3 months postoperatively returned to the normal reference level,while the maximum inspiratory pressure(PImax)at 12 months after operation was still slightly lower than the normal level,but it was significantly improved compared with preoperative value(P<0.05).The EMG data at 12 months postoperatively showed full interference potentials in 37 patients in bilateral posterior cricoarytenoid muscles during inspir
作者
李孟
郑宏良
陈世彩
朱敏辉
江昊
刘菲
高颖娜
王伟
张才云
陈梦婕
Li Meng;Zheng Hongliang;Chen Shicai;Zhu Minhui;Jiang Hao;Liu Fei;Gao Yingna;Wang Wei;Zhang Caiyun;Chen Mengjie(Department of Otorhinolaryngology Head and Neck Surgery,the First Affiliated Hospital of Navy Medical University,Shanghai 200433,China)
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2020年第11期1016-1021,共6页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
关键词
声带麻痹
喉返神经
神经再支配
膈神经
舌下神经
Vocal cord paralysis
Recurrent laryngeal nerve
Laryngealreinnervation
Phrenic nerve
Hypoglossal nerve
