CAJ | 학술논문

目的探讨声带浅固有层切除术治疗声带白斑的疗效及术后转归特点。方法2006年1月～2011年12月对138例声带白斑患者分别行声带黏膜剥脱术（剥脱组，69例）和声带浅固有层切除加或不加缝合术（切除组，69例），术前、术后2周、4周、6周、8周、3月、6月、12月行动态喉镜检查和嗓音主客观声学分析，观察两组疗效及术后转归特点。结果术后2周两组的声带黏膜波、声带振动对称性、规律性、总嘶哑度（G ）、jitter 、shimmer 、NHR值均明显低于术前，差异均有统计学意义（P＜0．05），但两组间无统计学差异（P＞0．05）。剥脱组术后4周动态喉镜、嗓音主客观声学分析均较术后2周明显改善，差异有统计学意义（P＜0．05），而与术后6周及之后各时间点比较均无统计学差异（P＞0．05）。切除组患者术后6周动态喉镜、嗓音主客观声学分析G、jitter 、shimmer 、NHR与术后2、4周比较差异均有统计学意义（P＜0．05），但与术后8周及以后各时间点比较均无统计学差异（P＞0．05）。剥脱组患者嗓音恢复更快，切除组复发率明显低于剥脱组，差异有统计学意义（P＜0．05）。结论声带浅固有层切除术治疗声带白斑复发率低，嗓音恢复良好，值得推广。
목적탐토성대천고유층절제술치료성대백반적료효급술후전귀특점。방법2006년1월～2011년12월대138례성대백반환자분별행성대점막박탈술（박탈조，69례）화성대천고유층절제가혹불가봉합술（절제조，69례），술전、술후2주、4주、6주、8주、3월、6월、12월행동태후경검사화상음주객관성학분석，관찰량조료효급술후전귀특점。결과술후2주량조적성대점막파、성대진동대칭성、규률성、총시아도（G ）、jitter 、shimmer 、NHR치균명현저우술전，차이균유통계학의의（P＜0．05），단량조간무통계학차이（P＞0．05）。박탈조술후4주동태후경、상음주객관성학분석균교술후2주명현개선，차이유통계학의의（P＜0．05），이여술후6주급지후각시간점비교균무통계학차이（P＞0．05）。절제조환자술후6주동태후경、상음주객관성학분석G、jitter 、shimmer 、NHR여술후2、4주비교차이균유통계학의의（P＜0．05），단여술후8주급이후각시간점비교균무통계학차이（P＞0．05）。박탈조환자상음회복경쾌，절제조복발솔명현저우박탈조，차이유통계학의의（P＜0．05）。결론성대천고유층절제술치료성대백반복발솔저，상음회복량호，치득추엄。
Objective To study the curative effects and characteristics of vocal cord shallow lamina propria resection on the treatment of vocal cord leukoplakia .Methods A total of cases of vocal cord leukoplakia were re-ceived vocal cord mucosa stripping surgery (69 cases) and vocal superficial lamina propria resection with or without suture (69 cases) respectively during January 2006 - December 2011 ,and all cases were taken dynamic laryngosco-py and voice acoustic analysis before surgery ,at 2 weeks ,4 weeks ,6 weeks ,8 weeks ,3 months ,6 months ,and 12 months after surgery .We observed the curative effects and characteristics after operation of two different surgery on the treatment of vocal cord leukoplakia with precancerous lesions .Results Two week after operation ,the vocal cords mucous wave ,vocal cords vibration symmetry ,regularity ,total hoarseness degree (G) ,Jitter ,Shimmer , NHRvaluesinthe2groupsweresignificantlylowerthanthoseofpreoperation(P<0.05),buttherewerenosignif-icant differences between the two groups(P>0 .05) .The three main index of dynamic laryngoscope ,voice acoustic parameters at 4 weeks after operation were significantly lower than those at 2 weeks after operation in the vocal cord mucosa stripping surgery group ,the difference were statistically significant (P<0 .05) ,but it showed no statistical difference between the group at 6 weeks after operation and the groups at other time points (P>0 .05) .The three main index of dynamic laryngoscope ,voice acoustic parameters at 6 weeks after operation were significantly lower than those at 2 ,4 weeks after operation in the vocal cord shallow lamina propria resection group ,the difference were statistically significant (P<0 .05) ,but it showed no statistical difference between the group at 8 weeks after operation and the groups of other time points (P>0 .05) .The voice restoration was faster in the vocal cord mucosa stripping surgery group .The recurrence rate was lower in the vocal cord shallow lamina propria resection group than those in the traditional vocal cord mucosa stripping surgery group ,the difference was statistically significant (P<0 .05) . Conclusion The vocal cord shallow lamina propria resection is a minimally invasive operation for the treatment of vocal cord leukoplakia ,with low recurrence rate and good the voice recovery .