Hu R, Xu W, Cheng L Y, Li X Y, Wang H Z
Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University; Key Laboratory of Otolaryngology Head and Neck Surgery(Capital Medical University), Ministry of Education, Beijing 100730,China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2023 Jan 7;58(1):28-36. doi: 10.3760/cma.j.cn115330-20220324-00129.
To investigate the long-term outcomes of patients with unilateral vocal fold paralysis resulting in dysphonia treated with lateral vocal fold autologous fat injection. To analyze the factors that may affect the long-term efficacy of the procedure. From July 2003 to June 2020, 163 patients (86 males and 77 females), aged 9-73 years (mean (34.50±12.94) years) with unilateral vocal fold paralysis resulting in dysphonia underwent transoral laryngoscopic injection of autologous fat into the lateral vocal folds. Subjective auditory perception assessment (GRBAS scale), objective acoustic assessment, voice handicap index (VHI) evaluation and stroboscopic laryngoscopy were compared before and after the surgery. Patients were followed up for 1 to 18 years, with median follow-up time of 6 years. SPSS 22.0 software was used for statistical analysis. Of 163 patients, 17 patients (10.4%) had mild hoarseness (G1) and 146 patients (89.6%) had moderate to severe hoarseness (G2-3). Stroboscopic laryngoscopy revealed an arch-shaped vocal fold on the affected side, fixed in the paramedian position or abduction position, with obvious glottic closure fissure. Postoperatively, voice recovered to normal (G0) in 139 patients (85.3%), mild hoarseness (G1) in 18 patients (11.0%) and moderate hoarseness (G2) in 6 patients (3.7%). Of these, 131 patients (80.4%) showed significant improvement in hoarseness, 29 patients (17.8%) showed mild improvement and 3 patients (1.8%) showed no significant improvement in hoarseness. Objective acoustic parameters of Jitter, Shimmer, NHR and MPT improved significantly, as did VHI scores. Stroboscopic laryngoscopy showed medialization of the affected vocal folds, improved vocal fold closure and normal or nearly normal vocal fold mucosal waves. With a fat injection volume of 3.0-4.5 ml, the patient's subjective auditory perception scores of G, R, B and A improved more significantly within 3 months after surgery, and both VHI and MPT were significantly better since 1 year after surgery. With bilateral vocal fold injection, the B and A scores improved significantly from 1 month postoperatively compared to unilateral injections(unilateral vs. bilateral injection 1 month post-operation, =1.42,=1.51,<0.05). The long-term efficacy of autologous fat injection in the paraglottic space for the treatment of unilateral vocal fold paralysis was stable. The efficacy of the surgery was related to the amount of fat injected, unilateral or bilateral of the injection.
探讨经口喉镜下自体脂肪注射治疗单侧声带麻痹所致声音嘶哑患者的远期疗效。分析可能影响该手术远期疗效的因素。2003年7月至2020年6月，163例（男86例，女77例）年龄9 - 73岁（平均(34.50±12.94)岁）单侧声带麻痹所致声音嘶哑患者接受经口喉镜下向患侧声带外侧注射自体脂肪治疗。比较手术前后的主观听觉感知评估（GRBAS量表）、客观声学评估、嗓音障碍指数（VHI）评估及频闪喉镜检查。患者随访1至18年，中位随访时间为6年。采用SPSS 22.0软件进行统计分析。163例患者中，17例（10.4%）为轻度声嘶（G1），146例（89.6%）为中重度声嘶（G2 - 3）。频闪喉镜检查显示患侧声带呈弓形，固定于旁正中位或外展位，声门闭合裂隙明显。术后，139例（85.3%）患者声音恢复正常（G0），18例（11.0%）为轻度声嘶（G1），6例（3.7%）为中度声嘶（G2）。其中，131例（80.4%）患者声嘶有显著改善，29例（17.8%）有轻度改善，3例（1.8%）声嘶无明显改善。Jitter、Shimmer、NHR和MPT的客观声学参数及VHI评分均有显著改善。频闪喉镜检查显示患侧声带内移，声带闭合改善，声带黏膜波正常或接近正常。脂肪注射量为3.0 - 4.5 ml时，患者术后3个月内G、R、B和A的主观听觉感知评分改善更显著，术后1年起VHI和MPT均显著更好。双侧声带注射时，术后1个月起B和A评分较单侧注射改善更显著（单侧与双侧注射术后1个月，=1.42，=1.51，<0.05）。声门旁间隙自体脂肪注射治疗单侧声带麻痹的远期疗效稳定。手术疗效与脂肪注射量、注射单侧或双侧有关。
