纤维喉镜下摘除声带息肉、小结245例临床分析

目的：探讨纤维喉镜下治疗声带息肉、小结的方法及效果。方法：应用纤维镜摘除声带息内２０３例,声带小结４２例。结果：随访３月～１年,平均６个月,发音正常１７９例,改善５７例,复发者９例。结论：纤维喉镜下摘除声带息肉、小结疗效满意。     

声带小结和声带息肉样变纤维喉镜下手术的护理

声带小结和声带息肉样变多因为用声不当及烟酒刺激引起的声带表面增生性病变,以声音嘶哑为主要临床表现.经纤维喉镜摘除声带小结和声带息肉样变的手术方法,既可避免直达喉镜或间接喉镜手术时的痛苦,又不象显微支撑喉镜手术那样需要全麻且住院,是近年来门诊治疗声带息肉及声带小结较理想的方法.本科 1986年起在省内较早开展纤维喉镜摘除声带小结和声带息肉样变的手术,现将有关手术的护理报告如下.     

纤维喉镜下声带小结、息肉摘除125例分析

目的：探讨电视监视下纤维喉镜声带小结,声带息肉摘除术的手术方法及优缺点。方法：使用日本产Olym-pusENF-T3型光导纤维喉镜,CLH-250型冷光源,SONY彩色监视器在表面麻醉下行声带小结、息肉摘除术125例。结果：125例中一次手术成功的120例,3例因息肉较大不能一次完全摘除病变组织。2例因咽反射较敏感无法耐受中止手术,均于1周后再次手术成功,结论：电视纤维喉镜声带小结、声带息肉摘除术较传统的手术方法,具有视野清晰、照明好、操作精细、损伤小,适应症广的优点。其缺点是对于较大的广基息肉难以一次手术完全摘除。     

纤维喉镜下声带息肉和声带小结摘除263例报告

我院1996年5月～2002年8月间在纤维喉镜下行声带息肉或小结摘除263例。现报告如下：     

显微支撑喉镜与纤维喉镜治疗声带息肉及小结的比较

对９０例声带息肉及声带小结分别行显微支撑喉镜下手术切除和纤维喉镜下手术摘除，其中５０例在显微支撑喉镜下进行，４０例在纤维喉镜下进行，经随访３个月～２年，将两种治疗方法进行了比较，结果显示：显微支撑喉镜下手术效果明显优于纤维喉镜下手术（χ２＝１８．３０，Ｐ＜０．０５），认为对声带息肉及声带小结，如无特殊疾病，应优先采用显微支撑喉镜下手术切除。     

纤维喉镜下脉冲Nd:YAG激光治疗声带小结和声带息肉的疗效分析

目的：探讨纤维喉镜下脉冲Nd：YAG激光治疗声带小结和声带息肉的疗效及其优越性。方法：采用表麻纤维喉镜下脉冲Nd：YAG激光治疗声带小结66例、声带息肉31例。结果：66例声带小结中治愈59例，治愈率为89％：31例声带息肉治愈28例，治愈率为90％，声带小结、声带息肉的总有效率为100％。结论：纤维喉镜引导下脉冲Nd：YAG激光治疗声带小结、声带息肉具有手术简便、病人痛苦小、术后反应轻、无喉水肿出现、恢复快、经济、疗效确切等优点。     

纤维喉镜下声带息肉小结摘除58例

我科自1996年11月至1998年4月采用纤维喉镜下摘除声带小结、息肉共58例，疗效满意，报道如下：     

纤维喉镜下治疗声带小结及息肉50例

目的　探讨纤维喉镜下声带小结及息肉的治疗方法与效果。方法　经纤维喉镜下治疗声带小结 2 0例 ,声带息肉 30例。结果　声带息肉治愈 2 6例 (86 .7% ) ,好转 3例 (10 % ) ,无效 1例 (3.3% )。声带小结治愈 18例 (90 % ) ,好转 1例 (5 % ) ,无效 1例(5 % )。术中术后均无并发症发生。结论　纤维喉镜下声带小结及息肉摘除术 ,是一种疗效好、操作方便、术后恢复快、值得推广的方法。     

声带息肉或小结手术方式的选择

[摘要] 目的：探讨声带息肉或小结手术方式的优劣，以提高手术成功率和手术效果。方法：回顾1982例声带息肉或小结手术患者，其中间接喉镜下切除息肉或小结1035例，支撑喉镜下切除息肉或小结656例，纤维喉镜下切除息肉或小结291例，并对手术的效果进行比较。结果：间接喉镜下切除息肉或小结有效率95.1%，无效率4.9%；支撑喉镜下切除息肉或小结有效率99.5%，无效率0.5%；纤维喉镜下切除息肉或小结有效率97.9%，无效率2.1%。结论：根据患者的身体状况、经济条件，息肉或小结的大小、位置及数量，手术者的经验选择不同的手术方式，才能取得经济且满意的效果。     

声带息肉或声带小结手术方式的选择

目的:探讨声带息肉或声带小结手术方式的优劣,以提高手术成功率和手术效果.方法:回顾1982例声带息肉或声带小结手术患者,其中间接喉镜下切除息肉或小结1035例,支撑喉镜下切除息肉或小结656例,纤维喉镜下切除息肉或小结291例,并对手术的效果进行比较.结果:间接喉镜下切除息肉或小结有效率95.1%,支撑喉镜下切除息内或小结有效率99.5%,纤维喉镜下切除息肉或小结有效率97.9%.结论:根据患者的身体状况、经济条件,息肉或小结的大小、位置及数量,手术者的经验选择不同的手术方式,才能取得经济且满意的效果.     

不同麻醉方法在支撑喉镜下声带息肉切除术中应用的比较

目的 比较不同麻醉方法在支撑喉镜下声带息肉切除术中的麻醉效果,并探讨各自优缺点.方法 将我院150例声带息肉患者患者随机分为硬膜外麻醉组、单纯全麻组和联合麻醉组,分别测定麻醉前、术中、术后去甲肾上腺素(NE)浓度和氧饱和度(SpO2).结果 三组的SpO2水平较麻醉前明显升高(P＜0.05);联合麻醉组NE水平与麻醉前比较差异无统计学意义(P＞0.05),与硬膜外麻醉、单纯全麻两组比较,差异有显著性(P＜0.05).结论 联合麻醉用于支撑喉镜下声带息肉摘除术,是一种安全、经济、有效的麻醉方法,可广泛应用于临床.     

优质护理干预在声带息肉患者术后嗓音康复中的应用

目的 探讨优质护理干预在声带息肉患者术后嗓音康复中的应用效果。 方法 选取2013年6月-2014年12月进行声带息肉摘除术的40例患者为对照组,给予常规护理;选取2015年1月-2016年6月进行声带息肉摘除术的40例患者为观察组,在对照组的基础上给予优质护理。比较2组患者嗓音声学参数的测试结果、治疗效果及患者对喉发声能力的自主评分。 结果 观察组基频微扰、振幅微扰、噪谐比与对照组比较差异均具有统计学意义。术后3个月,观察组治疗效果明显好于对照组(Z=-3.566,P<0.001),患者喉发声能力自主评分明显高于对照组(t=6.703,P<0.001)。 结论 优质护理干预可明显提高声带息肉患者术后嗓音康复质量。     

科学发声矫治法在显微喉镜下声带息肉切除术后康复中的作用

目的探讨科学发声矫治法在声带息肉患者术后康复中的作用。方法选取60例声带息肉术后患者,随机分为A、B两组,A组为综合治疗组,B组为综合治疗＋科学发声矫治法组,通过术后1、3、6个月门诊进行复查,观察患者术后的恢复情况。结果科学发声矫治法B组在音质改善及喉镜下声带黏膜的恢复情况明显好于A组（P〈0.05）。结论科学发声矫治法可以改善声带息肉术后患者的发音质量并降低其复发率。     

声带息肉、声带小结术后应用黄氏响声丸疗效观察

目的观察黄氏响声丸对显微喉手术切除声带息肉、声带小结术后疗效的影响。方法经直达喉镜显微镜下进行声带息肉、声带小结切除手术128例，随机分为观察组68例（在术后常规处理的基础上加用黄氏响声丸）和对照组60例（未州黄氏响声丸），随访3个月，比较两组疗效。结果观察组治愈显效率为95．6％，对照组治愈显效率为81．7％，丽组比较差异具有统计学意义（P〈0．05）。结论声带息肉、声带小结行显微喉手术切除术后，在常规处理的基础上加用黄氏响声丸能够促进声带的恢复、缩短病程。     

纤维喉镜下声带肿物切除术680例临床分析

目的探讨纤维喉镜下声带肿物切除术的临床分析。方法对680例声带肿物切除采用纤维喉镜联合间接喉钳行声带息肉摘除术。结果680例声带息肉患者全部完成手术,治愈577例（治愈率85％）,有效103例（有效率15％）。结论纤维喉镜联合间接喉钳下声带息肉摘除术,是一种实用、方便、有效的手术方法,适合临床上推广运用。     

Dynamic B-Mode Ultrasound Imaging of Vocal Fold Vibration During Phonation

We used B-mode imaging to study the vibratory phenomena of the vocal folds. The presence of multilayered structures of the vocal folds in the B-mode image was verified by using freshly excised human larynges in vitro. To capture images of vocal fold vibration, a special treatment was used to reconstruct the aliasing B-mode motion pictures of vocal fold vibration. Echo-particle image velocimetry (Echo-PIV) analysis was then applied to trace the tissue particles in the motion pictures. The vibratory behavior of the body (vocal ligament and muscle) of the vocal folds was revealed. Further analysis showed a quasi-longitudinal wave along the body of the vocal folds in the coronal plane. This is, to the best of our knowledge, the first time that vocal fold vibration physiology has been studied using B-mode imaging and Echo-PIV. (E-mail: tyhsiao@ntu.edu.tw)     

迷走神经损伤定位检查有助于单侧声带麻痹的病因诊断

目的探讨迷走神经损伤定位检查用于单侧声带麻痹病因诊断中的价值。方法对1例半年未能明确病因的单侧声带麻痹患者的诊疗过程进行回顾分析。结果本例因声音嘶哑半年就诊,在当地多家医院行相关医技检查均诊断为左侧特发性声带麻痹,予相应治疗症状无改善,来我院拟行声带自体脂肪注射术闭合声门。入我院后经追问病史、仔细查体及电子喉镜下吞咽功能检查发现左侧梨状窝有食物残留,考虑迷走神经节以上部位病变所致声带麻痹,经颅底增强MRI检查诊断为颈静脉孔区良性肿瘤。由于病变部位特殊,患者拒绝手术遂行伽马刀治疗,随访1年,肿瘤无变化。结论对于单侧声带麻痹患者切勿轻易诊断为单纯声带麻痹。电子喉镜下吞咽功能检查有助于确定迷走神经损伤部位,根据损伤部位有的放矢地进行检查,对单侧声带麻痹的病因诊断有临床指导价值。     

支撑喉镜下声带外展术治疗双侧声带麻痹的体会

目的 探讨支撑喉镜下声带外展术对声带麻痹的疗效。方法 对22例双侧声带麻痹患者行支撑喉镜下声带外展术。结果 17例行单侧声带外展术后，气管套管成功拔除，5例经双侧手术成功拔除套管。结论 支撑喉镜下声带外展术是一种通过对声带的减少容量手术并通过瘢痕向外牵拉声带使声门扩大。是一种操作简便、有效的术式。     

Utility of laryngeal electromyography in predicting recovery after vocal fold paralysis

OBJECTIVES: To determine the value of laryngeal electromyography in predicting recovery after vocal fold paralysis and to determine what elements of laryngeal electromyography are most predictive of outcome. DESIGN: Cohort study with retrospective data review. SETTING: University voice center. PARTICIPANTS: Consecutive sample of 31 patients with vocal fold paralysis diagnosed by indirect laryngoscopy, using either nasal insertion with a flexible nasopharyngoscope or peroral with a 70 degrees Hopkins rod. Inclusion criteria were that laryngeal electromyography had to have been performed between 21 days and 6 months from the onset of symptoms and patients must have been followed a minimum of 6 months. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Vocal fold motion at 6 months from onset of symptoms. RESULTS: Nine subjects (29%) had resolved vocal fold motion, whereas 22 (71%) had persistent vocal fold paralysis. By using our laryngeal electromyography paradigm, 4 of 6 patients with a laryngeal electromyography prognosis of excellent resolved. The predictive value for a negative test was 66.7%. For patients with a fair or poor prognosis, 5 of 25 resolved. The predictive value for a positive test was 80%. Only 8 of 22 patients with persistent vocal fold paralysis had fibrillations, and spontaneous activity was not significantly related to outcome. Patients with absent or greatly decreased motor unit recruitment had a significantly higher proportion of permanent vocal fold paralysis (P<.05). Stepwise forward logistic regression determined that prognosis by laryngeal electromyography and onset time were significant predictors of outcome (P<.01). The model predicted 44.4% of resolved cases, which represents a moderate prediction. CONCLUSIONS: This study confirms the utility of laryngeal electromyography in assessing prognosis for recovery of vocal fold motion after laryngeal nerve injury. The results support our hypothesis that preset decision rules based on laryngeal electromyography data can be effectively used to determine a prognosis for recovery of vocal fold motion.     

A phase I/II exploratory clinical trial for intracordal injection of recombinant hepatocyte growth factor for vocal fold scar and sulcus

Vocal fold scar and sulcus are intractable diseases with no effective established treatments. Hepatocyte growth factor (HGF) has preclinically proven to have potent antifibrotic and regenerative effects on vocal fold scar. The current Phase I/II clinical trial aims to examine the safety and effectiveness of intracordal injection of a recombinant human HGF drug for patients with vocal fold scar or sulcus. This is an open‐label, dose‐escalating, first‐in‐human clinical trial. Eighteen patients with bilateral vocal fold scar or sulcus were enrolled and divided into three groups: Step I received 1 μg of HGF per vocal fold; Step II received 3 μg of HGF; and Step III received 10 μg of HGF. Injections were administered once weekly for 4 weeks. The protocol treatment was performed starting with Step I and escalating to Step III. Patients were followed for 6 months post‐treatment. Local and systemic safety aspects were examined as primary endpoints, and therapeutic effects were assessed as secondary endpoints using voice handicap index‐10; maximum phonation time; vocal fold vibratory amplitude; grade, rough, breathy, asthenic, strained scale; and jitter. The results indicated no serious drug‐related adverse events in either the systemic or local examinations. In whole‐subject analysis, voice handicap index‐10, vocal fold vibratory amplitude, and grade, rough, breathy, asthenic, strained scale were significantly improved at 6 months, whereas maximum phonation time and jitter varied. There were no significant differences in phonatory data between the step groups. In conclusion, intracordal injection of a recombinant human HGF drug was safe, feasible, and potentially effective for human patients with vocal fold scar or sulcus.