神经源性声带运动障碍与喉神经电生理

声带运动障碍的病因和临床表现复杂多变，涉及多学科，从病因上分为神经源性和非神经源性。对于神经源性声带运动障碍的诊治，首先通过喉镜等检查明确有无声带运动障碍及严重程度，值得注意的是声带纵向张力变化障碍也属于运动障碍的范畴；然后采用喉肌电图（LEMG）检查进行定性分析，在确诊神经源性损伤后，进一步对神经损伤部位进行定位诊断并查找导致神经损伤的病因；同时根据喉部神经电生理评估结果，判断预后。最后综合上述的评估结果制定相应的治疗策略。     

Acoustic correlates of vocal effort: External factors and personality traits

ObjectivesTo develop an experimental protocol to study the vocal effort generated by introducing barriers to communication, and its relationship with certain personality traits.Material and methodsThe experimental protocol consisted of an interactive game in which the subject gave an investigator instructions to adopt various body positions (semi-directed communication situation). The Control situation included no constraints on communication. Then a Distance Constraint (increased distance between subject and investigator) and a Time Constraint (generation of performance stress by putting the subject in competition with others) were introduced. The vocal parameters studied comprised vocal intensity and fundamental frequency in the middle of the vowel of 3 target phonemes. Subjects also took the NEO FFI-R personality test.ResultsThe study included 41 women aged between 18 and 52 years. Vocal intensity and fundamental frequency increased significantly with the introduction of the constraints (P < 0.05), intensity passing from 75.5 dB to 81.8 dB and frequency from 249.4 Hz to 335.8 Hz. No correlations were found between these changes and results for the various personality traits.ConclusionsThis ecological protocol enables the impact of both physical and emotional obstacles to communication to be studied. No correlations between vocal effort and personality traits emerged. A larger-scale study would be necessary to analyze the continuum between vocal effort and vocal forcing, to improve speech therapy for dysfunctional dysphonia.     

电子鼻咽喉镜下声带息肉切除术疗效分析(附128例报告)

目的探讨电子鼻咽喉镜下声带息肉切除术的临床疗效。方法应用Dr．Speech4．0嗓音分析软件，对128例在电子鼻咽喉镜下切除声带息肉患者的嗓音声学参数进行分析比较。结果128例声带息肉患者术后7～15天Jitter、Shimmer、NNE、HNR、SNR恢复正常，与术前相比，差异有非常显著性意义(P＜O．01)；而FD与术前相比，差异无显著,Sk(P＞O．05)。结论电子鼻咽喉镜下声带息肉切除术具有操作简单、安全、费用低、疗效好的优点。     

He—Ne激光治疗声带小结的机理研究

我院应用He－Ne激光治疗551例声带小结，取得较好疗效。为研究作用机理，我们进行了免疫功能测定、测温试验、He－Ne激光照射前后的间接喉镜检查、显微结构研究、抑菌试验和过氧化脂质测定。结果提示He－Ne激光照射治疗声带小结的机理为照射后喉部温度升高、血管扩张、血循环加快，从而增强局部营养，促进喉部粘膜生长、消除组织水肿，加速炎性渗出物和毒素的排泄。而He－Ne激光本身没有杀菌和抑菌作用。     

In vivo measurement of the shear modulus of the human vocal fold: interim results from eight patients

The shear modulus of the vocal fold is an essential parameter required to enhance our understanding of how the vocal fold operates, to develop mathematical models of phonatation, and to provide benchmarks to quantify the effectiveness of surgical procedures. The authors announced the successful deployment of an instrument to measure vocal fold elasticity in vivo last year, and now present the data taken from eight patients in vivo. The shear modulus was measured at the mid-membranous point, in a transverse direction with respect to the axis drawn between the anterior commissure and vocal process. The range of mean shear modulus results is 701–2,225 Pa, with a mean value of 1,371 Pa.     

脐带穿刺术在胎儿先天性心脏病诊疗中的应用价值

目的探讨脐带穿刺在胎儿先天性心脏病诊疗中的应用价值。方法对34例行脐带穿刺的胎儿先天性心脏病例进行回顾性分析。结果34例均穿刺成功,未发生严重并发症。检出染色体异常6例,宫内巨细胞病毒感染1例。结论脐带穿刺术是一种安全有效改善妊娠结局的产前诊疗技术。     

声带鳞状细胞癌早期改变的病理学观察

目的探讨声带鳞状细胞癌早期病理学的特点，提高病理诊断水平。方法总结89例声带鳞状细胞癌早期改变病例的病理资料，对其石蜡切片进行HE染色、PAS染色及p53、Ki-67免疫组化染色；以59例声带角化症（分为单纯增生组40例和异型增生组19例）和30例声带浸润癌（浸润深度〉3mm的癌）作为对照。结果在HE染色下，声带鳞状细胞癌的早期改变可区分为两种类型：Ⅰ型为上皮全层癌变型，占67．4％（60／89）；Ⅱ型为上皮基底层及副基底层癌变型，占32．6％（29／89），又可分为Ⅱa和Ⅱb两个亚型。HE染色显示有可疑微小浸润者52例，PAS染色示其中的43例（83％）的可疑病灶周边基膜样物质消失，有微浸润，Ⅰ型微浸润的比例较Ⅱ型明显偏低（P=0．007）。HE染色下3例（3．4％，3／89）认为无微浸润者经深切证实有浸润，并经PAS染色确认。Ⅰ型和Ⅱ型的p53表达率差异无显著性（P=0．445），而Ki-67阳性率Ⅰ型高于Ⅱ型（P=0．048）。癌早期改变组的p53阳性率高于声带角化症伴单纯增生组（P=0．008），而与声带角化症异型增生组和声带进展癌组之间的差异无统计学意义（P=0．240，P=0．268）。癌早期改变组的Ki-67阳性率明显低于浸润癌组（P=0．000），并明显高于角化症伴单纯增生组（P=0．001），但与角化症伴异型增生组之间差异无显著性（P=0．248）。结论声带鳞状细胞癌早期改变可区分为Ⅰ型和Ⅱ型，Ⅱ型癌变可在不累及上皮全层的情况下，由上皮的基底层和（或）副基底层细胞直接向固有膜内增生及癌变，此型占全部病例的近1／3，早期浸润是Ⅱ型诊断的可靠依据；Ⅱ型的存在提示声带鳞状细胞癌的早期发生和演进可能存在不同的机制；PAS染色和p53、Ki-67免疫组化染色有助于声带鳞状细胞癌Ⅱ型早期的诊断。     

动态喉镜下咬检性切除早期声带癌

目的：利用动态喉镜观察声带振动及黏膜波动,以早期诊断声带癌,并在图象放大屏幕下活检性切除病变组织;术后动态观察手术侧声带振动及黏膜波的恢复情况,以冀早期发现声带癌复发。方法：对12例早期声带癌,利用动态喉镜活检性切除病变组织。经病理检查其中2例为原位癌,10例为表浅浸润癌。结果：术后11例恢复声带振动及黏膜波动;1例未恢复,予以预防性放疗。术后随访2年以上无肿瘤复发。结论：利用动态喉镜活检性切除早期声带癌并术后动态观察,于表麻下施术,患者痛苦小,治疗时间短,术后发声良好。     

女性单纯声带肥厚和声带小结的嗓音参数分析比较

目的：通过比较和分析单纯声带肥厚和声带小结的嗓音参数的变化,评价这些参数在两种疾病中诊断及疗效。方法：应用Dr.Speech(DSS)软件对成人女性30例单纯声带肥厚和声带小结患者做噪音测试,对其主要声学参数进行比较分析。结果：声带小结的嗓音声学参数、基频微扰、声门噪声能量NEE值均较声厚的各指标高。其中声门噪声能量在声结中异常者占99．6％,声带肥厚占80％,两组之间有显著性差异（P＜0．05）。其频微扰和振幅微扰的异常占有率,两组之间无显著性差异（P＞0．05）。结论：嗓音参数对诊断和区别声带肥厚和声结有一定的价值,特别是声门噪声能量有更高的敏感性,对诊断和治疗声带疾病有一定的价值。