Gao Y N, Chen S C, Chen D H, Li M, Wang W, Liu F, Zhu M H, Zheng H L
Department of Otorhinolaryngology Head and Neck Surgery, Changhai Hospital of the Second Military Medical University, Shanghai 200433, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2018 Sep 7;53(9):655-660. doi: 10.3760/cma.j.issn.1673-0860.2018.09.004.
To discuss the long-term efficacy of laryngeal reinnervation using the anterior root of the ansa cervicalis in the treatment of unilateral vocal fold paralysis (UVFP) caused by thyroid surgery. From January 2010 to January 2016, a total of 39 UVFP patients who underwent ansa cervicalis anterior root-to-recurrent laryngeal nerve (RLN) anastomosis and who had suffered nerve disfunction for 6 to 24 months were enrolled as UVFP group.Another 39 age and gender matched normal subjects served as control group. Videostroboscopy, vocal function assessment (acoustic analysis, perceptual evaluation and maximum phonation time), and laryngeal electromyography were performed preoperatively and postoperatively for assessing surgery efficacy. Paired sample test was used for statistical analysis. Videostroboscopic reports indicated that the glottic closure, vocal fold edge, vocal fold position, phase symmetry and regularity were significantly improved in the UVFP group (<0.01, respectively, postoperative vs. preoperative)and showed no statistical differences compared to the control group (>0.05, respectively). Both the postoperative GRBAS assessment and acoustic parameters were also significantly improved in the UVFP group, Pre-operative acoustic parameters/Post-operative acoustic parameters were 1.68±0.82/0.39±0.27, 10.08±2.56/4.58±2.96, 0.203±0.216/0.018±0.038, 5.96±1.92/17.42±4.11(<0.01, respectively) and Pre-operative acoustic parameters/Post-operative acoustic parameters were 0.39±0.27/0.32±0.19, 4.58±2.96/3.32±1.27, 0.018±0.038/0.014±0.027, 17.42±4.11/18.76±5.29, which showed no statistical differences compared to the control group (>0.05, respectively). Delayed laryngeal reinnervation with the anterior root of ansa cervicalis, it can restore the physiological laryngeal phonatory function to the normal or a nearly normal voice quality, which is a feasible and effective approach for the treatment of thyroid surgery-related UVFP.
探讨采用颈袢前根进行喉再支配术治疗甲状腺手术所致单侧声带麻痹(UVFP)的远期疗效。2010年1月至2016年1月,共纳入39例接受颈袢前根与喉返神经(RLN)吻合术且神经功能障碍6至24个月的UVFP患者作为UVFP组。另选取39例年龄、性别匹配的正常受试者作为对照组。术前及术后行频闪喉镜检查、嗓音功能评估(声学分析、主观评估及最长发声时间)及喉肌电图检查以评估手术疗效。采用配对样本t检验进行统计学分析。频闪喉镜检查报告显示,UVFP组声门闭合、声带边缘、声带位置、相位对称性及规律性均有显著改善(术后与术前相比,P均<0.01),与对照组相比无统计学差异(P均>0.05)。UVFP组术后GRBAS评估及声学参数也均有显著改善,术前声学参数/术后声学参数分别为:基频微扰1.68±0.82/0.39±0.27、谐噪比10.08±2.56/4.58±2.96、标准化噪声能量0.203±0.216/0.018±0.038、最长发声时间5.96±1.92/17.42±4.11(P均<0.01),术前声学参数/术后声学参数分别为:基频微扰0.39±0.27/0.32±0.19、谐噪比4.58±2.96/3.32±1.27、标准化噪声能量0.018±0.038/0.014±0.027、最长发声时间17.42±4.11/18.76±5.29,与对照组相比无统计学差异(P均>0.05)。采用颈袢前根进行延迟喉再支配术,可使喉的生理发声功能恢复至正常或接近正常的嗓音质量,是治疗甲状腺手术相关UVFP的一种可行且有效的方法。