CAJ | 학술논문

目的探讨自体筋膜加脂肪声带注射术治疗声门闭合不全的疗效.方法对26例单侧声带麻痹声门闭合不全患者全麻支撑喉镜下经口行声带内注射术,其中6例采用自体脂肪注射(A组),20例采用自体腹直肌前鞘筋膜加脂肪注射(B组).术前、术后动态喉镜检查和主客观嗓音分析评估疗效,均随访24个月.结果两组患者术后注射物无外溢,注射侧声带形态饱满;术后3 d注射侧声带出现急性炎性反应,3个月左右消退.术后3个月A组所有患者注射侧声带回复至中线,声门闭合良好,6～24个月声门闭合稍有缝隙;B组所有患者术后6个月回复至中线,声门闭合良好,6～24个月声带形态稳定.术前嗓音声学分析:两组间基频微扰、振幅微扰、标准化噪声能量及最大发音时间差异无统计学意义(P值均＞0.05);A组术后3个月显著改善(P值均＜0.01),6及24个月较术前改善(P值＜0.05或＜0.01),但较术后3个月音质下降(P值＜0.05或＜0.01);B组术后6个月显著改善(P值均＜0.01),6、12及24个月各参数差异均无统计学意义(P值均＞0.05);术后24个月两组的基频微扰、标准化噪声能量及最大发音时间差异有统计学意义(P值＜0.05或＜0.01).B组嗓音听感知评估,总嘶哑度、气息声、发音无力程度评分降低,与术前相比差异有统计学意义(P值均＜0.01).结论自体腹直肌前鞘筋膜加脂肪声带内注射术治疗单侧声带麻痹声门闭合不全可有效提高患者声音质量,远期效果稳定.
목적 탐토자체근막가지방성대주사술치료성문폐합불전적료효.방법 대26례단 측성대마비성문폐합불전환자전마지탱후경하경구행성대내주사술,기중6례채용자체지방주사(A조),20례채용자체복직기전초근막가지방주사(B조).술전、술후동태후경검사화주객관상음분석평고료효,균수방24개월.결과 량조환자술후주사물무외일,주사측성대형태포만;술후3 d주사측성대출현급성염성반응,3개월좌우소퇴.술후3개월A조소유환자주사측성대회복지중선,성문폐합량호,6～24개월성문폐합초유봉극;B조소유환자술후6개월회복지중선,성문폐합량호,6～24개월성대형태은정.술전상음성학분석:량조간기빈미우、진폭미우、표준화조성능량급최대발음시간차이무통계학의의(P치균＞0.05);A조술후3개월현저개선(P치균＜0.01),6급24개월교술전개선(P치＜0.05혹＜0.01),단교술후3개월음질하강(P치＜0.05혹＜0.01);B조술후6개월현저개선(P치균＜0.01),6、12급24개월각삼수차이균무통계학의의(P치균＞0.05);술후24개월량조적기빈미우、표준화조성능량급최대발음시간차이유통계학의의(P치＜0.05혹＜0.01).B조상음은감지평고,총시아도、기식성、발음무력정도평분강저,여술전상비차이유통계학의의(P치균＜0.01).결론 자체복직기전초근막가지방성대내주사술치료단측성대마비성문폐합불전가유효제고환자성음질량,원기효과은정.
Objective To evaluate the effect of combination of autologous fascia and fat injection into vocal fold for the treatment of patients with unilateral vocal fold paralysis and to observe the long-term effectiveness of this procedure. Methods A total of 26 unilateral vocal fold paralysis patients underwent vocal fold injection under general anesthesia, meanwhile, the mucosa of the injected point was sutured through laryngoscope under direct vision. There were 6 patients underwent autologous fat injection into vocal fold ( group A), and 20 patients underwent autologous anterior rectus sheath fascia and fat injection ( group B). Therapeutic efficacy were evaluated by videostroboscopy, voice-related parameters analysis and voice evaluation before and after treatment. Clinical analysis of this procedure was retrospectively performed in this serial of patients. Results All patients were followed up for 24 months. On the third day after operation,there was an acute inflammatory reaction induced by the graft. This reaction disappeared three months later.In all 20 eases, videolaryngostroboscopy showed significant improvement of the glottic closure, the improvement in acoustical parameters was statistically significant ( P ＜ 0. 01 ). Perceptual evaluation of GRBAS scale showed significant improvement of phonatory function on G, B, A scale. The results remained stable 6 -24 months after operation and were not changed by the length of follow-up. And in the 6 cases,videolaryngostroboscopy showed significant improvement of the glottic closure at 3 months compared with preoperative observation, a little spindle-shaped disclosure. The improvement in acoustical parameters was significant statistically at 3, 6 and 24 months (P ＜ 0. 05 or ＜ 0. 01 ), the voice quality decreased significantly at 6 and 24 months compared with 3 months (P ＜0. 05 or ＜0. 0l ). The significant differences were not observed between 6 and 24 months (P ＞ 0. 05 ). No complications were observed in all patients perioperatively or during the follow-up period. Voice-related parameters jitter, normalized noise energy and maximum phonation time showed significant differences between Group A and Group B on 24 months ( P ＜0. 05 or ＜ 0. 01 ). Conclusion The combination of autologous fascia and fat vocal fold injection is an effective procedure for the treatment of unilateral vocal fold paralysis, and the stable results can be achieved during the follow-up period for 24 months.