声带癌T1病变的CO2激光治疗

本文报道应用支撑喉镜、ＣＯ２激光治疗Ｔ１声带癌病人３２例，取得了良好的治疗效果，随诊１￣３年病人全部存活，局部复发率９．３％（３／３２），喉功能保全好。提示ＣＯ２激光手术是治疗Ｔ１声带癌的有效方法，具有良好的应用前景，但应严格掌握适应证。     

声带癌T＿1病变的CO＿2激光治疗

本文报道应用支撑喉镜、ＣＯ—２激光治疗Ｔ—１声带癌病人３２例，取得了良好的治疗效果。随诊１～３年病人全部存活，局部复发率９．３％（３／３２），喉功能保全好。提示ＣＯ２激光手术是治疗Ｔ—１声带癌的有效方法，具有良好的应用前景，但应严格掌握适应证。     

声带癌治疗前后嗓音声学检测及动态喉镜检查的对比分析

本文应用嗓音的主观、客观评价方法对３０例声带癌患者应用激光或放射治疗前后嗓音分析与动态喉镜检查结果相对比，经统计学相关分析得出如下结论：①由于激光或放疗对声带造成的损伤影响声带闭合，使喉发音时气体从声门漏出而产生气息型嗓音；②声带癌患者治疗前与治疗后嗓音声学参数对比分析未见有统计学显著性差异；③嗓音声学分析参数与０．Ｂ．Ｓ型心理听觉参数呈正相关；④嗓音声学参数与动态喉镜检查结果进行相关分析发现ＡＰＱ与ＧＬＯ，ＮＮＥａ与ＡＭＰ，ＮＯＮ呈显著性正相关（Ｐ＜０．０５）。     

内窥镜CO_2激光联合外进路治疗侵及前联合的声带癌:动物研究

对６只狗进行了内窥镜ＣＯＺ激光联合甲状软骨开窗外进路手术治疗侵及前联合（ＡＣ）的声带癌的活体研究，结果显示满意的解剖结构和能接受的发音功能。６只成年小猎兔犬，全麻下手术。用带ＣＯ。激光微小控制器（０．３ｍｍ光点）的手术显微镜，用ＣＯ。激光１．５～２．ＳＷ连续方式作喉内切口达软骨，包括右侧声带、ＡＣ和左声带前１／３。继做颈部横切口分开带状肌，形成软骨膜瓣，暴露喉框架，用一２２号针从甲状软骨中１／３插入喉腔内，内窥镜下观察以确保软骨管在喉腔内正确位置。在内窥镜指引下切除１５Ｘ２５ｍｍ的甲状软骨（形成…     

声带癌治疗前后嗓音学检测及动态喉镜检查的对比分析

本文应用嗓音的主观１客观评价方法对３０例声带癌患者应用激光或放射治疗前后嗓音分析与动态喉镜检查结果相比，经统计学相关分析得出如下结论：（１）由于激光或放疗对声带造成的损伤影响声愈合，使喉发音进气体从声门漏出而产生气息型嗓音；（２）声带癌患者治疗前与治疗后嗓音声学参数对比分析未见有统计学显著性差异；（３）嗓音声学分析参数与Ｇ．Ｂ．Ｓ型心理听觉参数呈正相关；（４）嗓音声学参数与动态喉镜检查结果进行相关     

环状软骨上部分喉切除术,环状软骨、舌骨、会厌吻合术治疗侵及前联合的T_1～T_2N_0早期声门癌

从历史上来看,侵及前联合的Ｔ１～Ｔ２Ｎｏ早期声门癌多采用垂直半喉切除术（ｖｅｒｔｉｃａｌｎａｒｔｌａｌｌａｒｖｎｓｅｃｔｏ－ｍｙ,ＶＰＬ）或放射治疗。激光治疗曾一度兴起,然而很快便因为很高的局部复发率而摒弃。在作者单位,１９８０年以前Ｔ１～Ｔ２Ｎｏ声...     

CO_2激光处理喉垂直部分切除术后拔管困难

为解除喉部分切除术后声门狭窄，提高拔管率，对１６例喉垂直部分切除术后拔管困难的患者应用支撑喉镜暴露、ＣＯ２激光治疗，取得了良好的治疗效果，再拔管率８７．５％（１４／１６）。随诊１～３年，疗效稳定。结果表明ＣＯ２激光手术是治疗喉垂直部分切除术后拔管困难的新的有效的方法     

计算机声学测试在发声障碍鉴别诊断中的应用

目的 观察器质性与功能性发声障碍噪音学参数及声谱图表征,探讨计算机声学检测系统在发声障碍鉴别诊断中的应用价值。方法 采用计算机噪音声学测试系统（Ｄｒ．Ｓｐｅｅｃｈ Ｓｃｉｅｎｃｅ ｆｏｒ Ｗｉｎｄｏｗｓ）对７０例正常成人、６０例器质性声带疾病及５０例功能性发声障碍噪音元音信号“ａ”进行测试,观察分析其声学参数（ｊｉｔｔｅｒ,ｓｈｉｍｍｅｒ,ＮＮＥ）及声谱图特征。结果 ６０例器质性声带疾病嘶哑噪音表     

梨状窝癌的喉保存:欧洲癌症研究与治疗组织Ⅲ期试验的初步结果

下咽癌患者多就诊较晚，需联合治疗。通常的治疗模式是：全喉切除十部分咽切除、根治性颈廓清、术后放疗，患者失去言语功能。随着对头颈癌有效的化疗方案的采用，已有报道证实治疗下咽癌时喉保存的可行性。为比较治疗梨状窝癌保存喉（对敏感患者诱导化疗加控制性放疗，不敏感者手术）与常规手术两种治疗方法的结果，欧洲癌症研究与治疗组织（ＥＯＲＴＣ）从１９９０年开始进行前瞻性随机分组的Ⅲ期试验。经病理学证实的、未治疗的梨状窝或杓会厌襞癌患者，ＴＮＭ分期为Ｔ２（除外梨状窝膜部外生型Ｔ２病变）、Ｔ３或Ｔ４、Ｎ０、Ｎ１、Ｎ２…     

二氧化碳激光喉内显微手术(附32例报告)

二氧化碳激光喉内显微手术（ＣＯ２Ｌａｓｅｒ ＥｎｄｏｌａｒｙｎｇｅａｌＭｉｃｒｏｓｕｒｇｅｒｙ,ＣＯ２－ＬＥＬＭ）是现代喉科,特别是音声外科的一项重要技术。国外在７０年代初由Ｓｔｒｏｎｇ和Ｊａｋｏ首先开展［１］,国内由于尚未研制成功相关的仪器设备,且进口价格昂贵,至令尚未广泛开展。我科与浙江大学光电子技术研究所合作研制了ＣＯ２激光显微外科治疗仪［２］,并用此仪器作了３２例 ＣＯ２－ＬＥＬＭ,兹报告如下。１资料与方法１．１对象 ３２例中,男、女各１６例;年龄２２岁～７９岁,平均４３．５岁,病种：喉乳…     

Vocal function following carbon dioxide laser surgery for glottic carcinoma

Vocal function following laser surgery for glottic T1a carcinoma was evaluated in 17 patients and compared to vocal function following radiotherapy in 14 patients. The results are summarized as follows. 1) A slight degree of hoarseness was found more frequently following laser surgery than following radiotherapy. The quality of hoarseness was rough and breathy in most cases. 2) In stroboscopic examination, incomplete glottal closure and diminution or lack of vibration of the operated vocal fold were frequently observed following laser surgery. 3) There was no marked difference in maximum phonation time, mean airflow rate, fundamental frequency range of phonation, intensity range of phonation, and intensity-flow ratio between the laser and the radiotherapy groups. On the basis of these results, we conclude that there is little difference in vocal function between postlaser and postradiotherapy patients as far as conversational voice is concerned.     

Acoustic analysis of pathological voice. Some results of clinical application

Tape-recorded voices of 30 patients were acoustically analysed: 10 had glottic Tla carcinoma, 10 unilateral vocal fold polyp and 10 unilateral recurrent laryngeal nerve paralysis. The carcinoma cases were treated with laser surgery with/without radiotherapy, the polyp cases with endolaryngeal microsurgery and the paralysis cases with intrafold silicone injection. The acoustic analysis was conducted before and after the treatment for each patient. Three acoustic parameters, viz. pitch perturbation quotient (PPQ), amplitude perturbation quotient (APQ) and normalized noise energy (NNE), were employed. The results were as follows: (1) PPQ and APQ were greater in paralysis cases than in carcinoma and polyp cases; (2) none of the parameters was useful in differentiating the three disease groups investigated; (3) all three parameters proved to be useful in monitoring the effects of treatments; (4) all three parameters were positively correlated to the grade of hoarseness, rough and breathy quality of hoarseness, mean airflow rate and regularity of vocal fold vibration viewed under stroboscopy; (5) PPQ, APQ and NNE were positively related to each other.     

声带注射治疗声带麻痹及检测喉发音的研究

对30例不同病因所致单侧声带麻痹患者,采用经环甲间隙穿刺声带注射硅胶的方法进行治疗.治疗前后对患者的最长发音时间(MPT)、喉平均呼气流率(MFR)、基频值(F_0)、声强级(SPL)、频率微扰商(PPQ)、振幅微扰商(APQ)、噪声能量级(NNE),频闪喉镜下声带振动发音过程中的对称性(SYM)、规则性(REG)、振幅(AMP)、闭合状态(GLO)、粘膜波动(MUC)、等质性(NON)和嗓音心理听觉评价参数:音哑总分度(G)、粗糙型(R)、气息型(B)、无力型(A)、紧张型(S)进行检测,并对测试结果进行统计学分析.实验结果表明,上述各项参数值在治疗后较治疗前有明显改善,其中MPT、GLO值的增高,MFR、PPQ、APQ、NNE值下降表现最明显:心理听觉评价参数GRBAS值治疗后较治疗前也有明显好转.对各参数进行统计学分析得出:声带麻痹嗓音中噪音成分主要同声带振动的规则性、振幅和粘膜波呈正相关(P<0.05或 P<0.01).声带麻痹嗓音的主观心理听觉评价是以气息型和无力型为主.它主要与喉平均呼气流率,声带振动的规则性、闭合度、振幅、声带粘膜波及对称性呈正相关.从而证明,经环甲间隙声带注射硅胶治疗单侧声带麻痹是一种简单、实用、安全的治疗方法.若一次不成功还可以重复治疗.     

Voice function following CO2 laser microsurgery for precancerous and early-stage glottic carcinoma

CONCLUSIONS: With the cover layer injured, vocal function of mucosal ablation could be protected and even return to normal after surgery and vocal function of mucosal stripping was slightly affected with extensive mucosal injury. Once the body layer was injured, the compensatory mechanism would play an important role in phonation. OBJECTIVES: To investigate voice function following CO2 laser microsurgery for precancerous and early-stage glottic carcinoma. PATIENTS AND METHODS: Vocal function was examined by acoustic analysis, aerodynamic analysis and videostroboscopic examination. RESULTS: For mucosal ablation, vocal quality recovered 1 month after surgery. For mucosal stripping, although vocal quality was steady 3 months after surgery, slight hoarseness persisted in this group. The contour of the treated fold recovered postoperatively. There were no complications in recovery. For cordectomies, vocal quality became steady 6 months after the surgery. The supraglottal hyperfunction with supraglottal structure squeezing played an important role in phonation. The affected vocal fold mucosal wave was absent instead of a regular ventricular fold wave or mucosal wave of the vocal process during phonation. In comparison with the type III-IV cordectomy, the results of extended cordectomies (type Va and Vc) were worse; however, the difference was not statistically significant. Granulomas and anterior commissure webs were present. All granulomas resolved spontaneously 3 months postoperatively.     

Voice quality after laser surgery or radiotherapy for T1a glottic carcinoma

OBJECTIVE: To compare the effect on phonation of radiotherapy and endoscopic laser surgery for stage T1a glottic squamous cell carcinoma. STUDY DESIGN: Retrospective. METHODS: Patients treated for stage T1a glottic carcinoma from August 1994 to March 2000 and who had been followed for at least 1 year were candidates. Eight patients who underwent radiotherapy and 22 who underwent laser surgery were enrolled. Indirect laryngoscopy and stroboscopic examination were performed, and voice quality was analyzed using standard parameters. RESULTS: Maximum phonation time, average airflow rate, sound pressure level, and average fundamental frequency during unconditional phonation were similar after laser surgery and radiotherapy. However, compared with normal men who were 50 years of age or older, the average fundamental frequency was higher after laser surgery. CONCLUSIONS: Contrary to some reports, the voice quality is minimally affected by laser surgery for T1a glottic carcinoma, and outcome is similar to radiotherapy. The average fundamental frequency is higher than normal after laser surgery, but the effect on the quality of life was trivial.     

Relationships between the degree of lesion and that of vocal dysfunction in vocal fold polyp

Relationships between the degree of lesion and that of vocal dysfunction were investigated in 122 cases of vocal fold polyp. A normalized size of polyps and glottic gap were correlated to the results of phonatory ability tests, stroboscopic investigations, acoustic analyses, and perceptual evaluations. There was no significant correlation between the size and the gap. The size of polyp was negatively correlated to fundamental frequency, whereas it was positively correlated to roughness of voice, asymmetry of vocal fold vibration, irregularity of vocal fold vibration, pitch perturbation quotient, amplitude perturbation quotient, and normalized noise energy. The glottic gap showed negative correlations to maximum phonation time and sound pressure level, and positive correlations to mean airflow rate and fundamental frequency.     

Airflow and temperature distribution inside the maxillary sinus: a computational fluid dynamics simulation

Conclusions. With the cover layer injured, vocal function of mucosal ablation could be protected and even return to normal after surgery and vocal function of mucosal stripping was slightly affected with extensive mucosal injury. Once the body layer was injured, the compensatory mechanism would play an important role in phonation. Objectives. To investigate voice function following CO₂ laser microsurgery for precancerous and early-stage glottic carcinoma. Patients and methods. Vocal function was examined by acoustic analysis, aerodynamic analysis and videostroboscopic examination. Results. For mucosal ablation, vocal quality recovered 1 month after surgery. For mucosal stripping, although vocal quality was steady 3 months after surgery, slight hoarseness persisted in this group. The contour of the treated fold recovered postoperatively. There were no complications in recovery. For cordectomies, vocal quality became steady 6 months after the surgery. The supraglottal hyperfunction with supraglottal structure squeezing played an important role in phonation. The affected vocal fold mucosal wave was absent instead of a regular ventricular fold wave or mucosal wave of the vocal process during phonation. In comparison with the type III–IV cordectomy, the results of extended cordectomies (type Va and Vc) were worse; however, the difference was not statistically significant. Granulomas and anterior commissure webs were present. All granulomas resolved spontaneously 3 months postoperatively.     

Multidimensional Assessment of Voice Characteristics After Radiotherapy for Early Glottic Cancer

Objectives/Hypothesis: To assess voice characteristics of patients following radiotherapy for early glottic cancer through a multidimensional analysis protocol including vocal function and voice quality measures. Methods: Voice analyses were performed for 60 patients treated with radiotherapy (66 Gy/33 fractions, 60 Gy/30 fractions, or 60 Gy/25 fractions) for early T1 glottic cancer and 20 matched control speakers. There was a longitudinal group of 10 patients for whom data were collected before as well as 6 months and 2 years after radiation. Furthermore, data were collected for five separate groups of 10 patients each, before, 6 months after, 2 years after, 3 to 7 years after, and 7 to 10 years after radiation. Vocal function was investigated by means of videolaryngostroboscopy, phonetography, maximum phonation time, and phonation quotient measures. Voice quality was assessed by means of objective acoustical analysis and subjective perceptual ratings by trained raters. Results: Voice characteristics of patients were decreased before radiotherapy, improved after treatment, and became comparable to the voice characteristics of control speakers in at least 55% of the patients. Following radiotherapy, deviant voice quality was mainly negatively affected by increased age and stripping the vocal cord for initial diagnosis. Stroboscopy revealed that next to increasing age and stripping the vocal cord, continued smoking after treatment decreased vocal function following radio-therapy. Conclusion: Voices of patients diagnosed with early glottic cancer improved but did not normalize fully after radiotherapy. Stripping the vocal cord for initial diagnosis and continued smoking after treatment decreased voice characteristics. A multidimensional analysis protocol including perceptual and acoustical analysis of voice quality and stroboscopic analysis of vocal function is recommended to investigate voice characteristics following treatment for early glottic cancer.     

CO_2激光与喉显微手术治疗声带息肉的疗效对比

目的 比较ＣＯ２激光与喉显微手术治疗声带息肉的治疗效果。方法 ６０例声带息肉患者分为激光组和喉显微手术组，每组各３０例。患者手术后行间接喉镜声带检查、嗓音声学分析、主观听觉评价分析。结果激光组术后声带形态的恢复时间要长于喉显微手术组；激光组术后声学参数中的ＰＰＱ值大于而Ｈ／Ｎ值小于显微手术组；激光组术后的嗓音主观听觉评价以粗糙型和紧张型为主，而喉显微手术组仅以粗糙型为主。结论 对声带息肉的治疗喉显微手术方法优于激光手术，喉显微手术较激光手术对组织损伤小，术后愈合时间短，术后嗓音恢复快，同时也减轻了患者的经济负担。     

Quality of life and functional outcomes in the management of early glottic carcinoma: a systematic review of studies comparing radiotherapy and transoral laser microsurgery

Clin. Otolaryngol. 2010, 35 , 373–382 Background: Early glottic carcinoma can be managed by radiotherapy and transoral laser microsurgery with similar control and survival rates. The functional and quality of life outcomes of these interventions are therefore important to guide management. Objective of review: To compare the different treatment modalities for early glottic carcinoma with respect to quality of life, post-treatment voice character and swallowing outcomes. Type of review: A systematic review of the literature with defined search strategy. Search strategy: Searches of EBM databases, and literature databases using key words: glotti*, laryn*, neoplasm, radiotherapy and laser surgery from 1970 to November 2009. Articles were screened for relevance using pre-determined inclusion and exclusion criteria. Evaluation method: Articles reviewed by authors and data compiled in tables for analysis. Results: No randomised controlled trials were identified. There were 15 studies reporting vocal outcomes, and perception of voice disability was measured in eight studies; numbers were low in all the papers. Cumulatively, results for 880 patients were included, 448 had trans-oral laser microsurgery and 442 had radiotherapy. For vocal outcomes, 12 studies found no significant difference between radiotherapy and laser surgery, three reported superior outcomes for radiotherapy, whereas for the perception of voice disability, five reported no difference between treatment groups, while the remaining three reported conflicting results. Nine studies reported quality of life outcomes; seven of these reported no difference between the treatment groups in overall scores although some report differences in subsets of questions. Conclusions: The evidence base to date demonstrates comparable vocal and quality of life outcomes for radiotherapy and transoral laser surgery for early glottic carcinoma. There is a need for consensus on which measures of vocal quality and life satisfaction to be used in research trials to allow comparison between studies.