Gao Yingna, Chen Shicai, Wang Wei, Li Meng, Zhu Minhui, Huang Rushi, Peng Jieying, Li Haopu, Zheng Hongliang
Department of Otorhinolaryngology Head and Neck Surgery,the First Affiliated Hospital of Naval Medical University(Changhai Hospital),Shanghai,200433,China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2024 Oct;38(10):907-911. doi: 10.13201/j.issn.2096-7993.2024.10.005.
Investigates the application and clinical efficacy of ansa cervicalis anterior root-recurrent laryngeal nerve(RLN) anastomosis in the treatment of unilateral vocal fold paralysis(UVFP). A prospective study was conducted with 92 UVFP patients admitted to our department from January 2018 to January 2022 who received ansa cervicalis anterior root-RLN anastomosis. The course of nerve injury ranged from 6 to 24 months. Videostroboscopy, voice subjective auditory perceptual assessment(GRBAS), Voice Handicap Index(VHI-10), voice objective acoustic analysis and laryngeal electromyography(EMG) were used to evaluate the efficacy of the operation. Videostroboscopy showed that although the movement of vocal cords did not return to normal 12 months after operation, their volume and muscle tension were significantly improved and their positions were adducted to the median or near-median. Also the glottic closure, vocal cord position, vocal cord edge, symmetry and regularity of vocal cord vibration were significantly improved than pre-operation(<0.01). The five indexes of GRBAS(Grade, Roughness, Breathiness, Asthenia, Strain) and VHI-10, as well as voice acoustic parameters(Jitter, Shimmer, NHR) post-operation were significantly reduced, while the maximum phonation time(MPT) was significantly longer(<0.01). The results of laryngeal EMG indicated that the maximum voluntary motor unit recruitment(VMUR) post-operation was significantly recovered(<0.01), which confirmed that the affected laryngeal muscle obtained effective nerve reinnervation. Ansa cervicalis anterior root-RLN anastomosis can effectively improve the voice function of patients which is safe and satisfactory. It is an ideal method for the treatment of unilateral RLN injury.
探讨颈襻前根-喉返神经(RLN)吻合术在单侧声带麻痹(UVFP)治疗中的应用及临床疗效。对2018年1月至2022年1月收治于我科的92例接受颈襻前根-RLN吻合术的UVFP患者进行了一项前瞻性研究。神经损伤病程为6至24个月。采用频闪喉镜检查、嗓音主观听觉感知评估(GRBAS)、嗓音障碍指数(VHI-10)、嗓音客观声学分析及喉肌电图(EMG)评估手术疗效。频闪喉镜检查显示,术后12个月声带运动虽未恢复正常,但其体积和肌张力明显改善,位置内收至中线或接近中线。声门闭合、声带位置、声带边缘、声带振动的对称性和规律性也较术前显著改善(<0.01)。术后GRBAS的五个指标(分级、粗糙、气息、无力、紧张)、VHI-10以及嗓音声学参数(抖动、闪烁、噪声谐波比)均显著降低,而最长发声时间(MPT)显著延长(<0.01)。喉肌电图结果表明,术后最大自主运动单位募集(VMUR)显著恢复(<0.01),证实患侧喉肌获得了有效的神经再支配。颈襻前根-RLN吻合术能有效改善患者的嗓音功能,安全且效果满意。是治疗单侧RLN损伤的理想方法。