摘要
目的探讨闭合性喉外伤伴杓区损伤的临床特征、内镜下手术治疗及疗效。方法回顾性研究2007年4月至2018年12月因明显声音嘶哑就诊于首都医科大学附属北京同仁医院耳鼻咽喉头颈外科的闭合性喉外伤伴杓区损伤患者12例,其中男10例,女2例,年龄7~48岁,中位年龄21岁,患者均在全身麻醉和支撑喉镜下行喉显微修复手术。评估其临床特点、喉镜表现、喉部CT特征、内镜手术方法及疗效。对比手术前后患者的发音质量主、客观参数,采用SPSS 22.0软件进行配对t检验。结果 12例患者在外伤后均立即出现明显的声音嘶哑伴咽喉部疼痛及发音痛、咯血性分泌物,无呼吸及吞咽困难。3例患者有轻微的颈部皮下气肿。喉镜发现14侧声带运动不良,损伤时间<48 h的4例患者的杓区和/或室带、声门后部黏膜撕脱,杓状软骨暴露4侧;损伤时间≥48 h的8例患者发现杓区、室带覆有较厚伪膜或肉芽,结构异常。术中探查发现,共17侧杓区(双侧5例,单侧7例)存在不同程度损伤,3侧仅声带突黏膜局限撕裂;14侧室带、声带黏膜自杓区垂直方向撕脱、杓状软骨暴露,其中杓状软骨形态异常6侧,骨折移位8侧。喉部CT显示,声带运动不良侧的声门和/或声门上结构呈不规则增厚,双侧杓状软骨结构不对称3例,伴移位2例。采用显微手术修复缝合撕脱的喉黏膜、软骨膜及杓状软骨,术后患者声音嘶哑即刻明显改善,术后3个月患者的发音质量参数[总嘶哑度(G)、粗糙声(R)、气息声(B)、弱音(A),频率微扰(jitter)、振幅微扰(shimmer)、噪谐比(NHR)和最长发声时间(MPT)]与术前相比有明显改善(t值分别为12.792、12.792、10.340、3.276、2.865、3.781、3.173、3.090,P值均<0.05)。除1例患者出现声带瘢痕外,其余患者喉形态正常,声带运动恢复正常。随访期间均未发现喉狭窄。结论对于闭合性喉外伤伴有明显声音嘶哑者,喉镜下发现声带运动
Objective To investigate the clinical characteristics,diagnosis,endoscopic surgical procedures,and therapeutic effect of blunt laryngeal trauma with arytenoid injury.Methods We retrospectively reviewed 12 patients who suffered blunt laryngeal trauma with laryngeal mucosa avulsion and arytenoid region injury at the Department of Otorhinolaryngology Head and Neck Surgery,Beijing Tongren Hospital from April 2007 to December 2018.Among the 12 patients,10 were males,2 were females,aged from 7 to 48 years old,with a median age of 21 years old.All patients were performed with transoral endoscopic laryngeal microsurgery under general anesthesia.Clinical characteristics,laryngoscopic signs,laryngeal CT,endoscopic surgical findings and procedures,and therapeutic effect were analyzed.The subjective and objective parameters of the voice quality of patients before and after surgery were compared using SPSS 22.0 statistical software by paired T test.Results All patients had a history of obvious dysphonia immediately after trauma,accompanied by throat pain and hemoptysis without obvious dyspnea and dysphagia.Slight subcutaneous emphysema was found in 3 patients by physical examination.Laryngoscope revealed that 14 sides of vocal folds immobilized,arytenoid and/or ventricular region and posterior glottis mucosa were avulsed in 4 patients within 48 h of injury,and arytenoid cartilage was exposed in 4 sides.The arytenoid and ventricular regions were covered with thick pseudo-membrane or granulation,with abnormal structure in 8 patients with damage of more than 48 h.Intraoperative exploration revealed that there were 17 sides of arytenoid region(bilateral 5 cases,unilateral 7 cases)with varying degrees of injury.There was only limited laceration on three sides of the vocal folds.The lateral ventricular and vocal fold mucosae were avulsed vertically from the arytenoid region and arytenoid cartilage was exposed in 14 sides,among which 6 sides had abnormal arytenoid cartilage morphology and 8 sides had fracture displacement.Laryngeal
作者
胡蓉
徐文
杨庆文
程丽宇
Hu Rong;Xu Wen;Yang Qingwen;Cheng Liyu(Department of Otorhinolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)
出处
《中华耳鼻咽喉头颈外科杂志》
CSCD
北大核心
2021年第3期256-262,共7页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
基金
北京市医院管理中心临床医学发展专项“扬帆”计划(XMLX201848)
北京市医院管理局“青苗”计划专项经费(QML20170201)
北京市东城区优秀人才培养基金。
关键词
声嘶
闭合性喉外伤
杓区损伤
黏膜撕脱
声带运动不良
喉内镜显微手术
Hoarseness
Blunt laryngeal trauma
Arytenoid region injury
Mucosal avulsion
Vocal fold immobility
Endolaryngeal microsurgery
