声带运动不良的喉肌电图特征

目的探讨声带运动不良的喉肌电及诱发肌电变化特征。方法对108例声带活动不良患者临床表现、喉肌电图(自发电位、运动单位电位及募集电位等)及神经诱发电位特征(潜伏期、时程、波幅)进行分析。结果喉返神经麻痹者患侧甲杓肌、环杓后肌可检测到失神经电位如纤颤波和正锐波及再生电位。完全麻痹者肌电为电静息,相应喉内肌诱发电位消失。神经不完全损伤者患侧相应喉肌正常运动单位电位中夹杂失神经电位或再生电位,募集电位为单纯相或混合相,神经诱发电位较弱,其中患侧甲杓肌(2.2±1.0)ms(±s,以下同)、环杓后肌(2.4±1.0)ms 诱发电位平均潜伏期均大于正常受试者(P<0.05);诱发电位波幅离散程度较大,患侧甲杓肌(0.9±0.7)mV、环杓后肌(1.2±1.0)mV 平均诱发电位波幅均明显小于正常受试者(P<0.05)。环杓关节运动障碍者喉肌电正常或稍活跃,神经诱发电位参数与正常无统计学差异。肿瘤侵犯喉肌患者肌电减弱,神经诱发电位潜伏期正常,波幅减小。结论声带活动不良可以通过常规喉肌电图进行初步定性筛查,后经喉神经诱发电位进一步进行半定量分析。     

喉麻痹患者喉肌电图结果的观察

目的探索喉肌电图检查在单侧喉麻痹诊断中的应用价值。方法回顾性研究18例单侧喉麻痹者的喉肌电检查结果及其它临床资料，分析患侧喉肌电募集模式、是否有失神经及神经再生电位以及甲杓肌、环杓后肌的电活动是否存在正常相位等参数特征，并与健侧相关参数进行比较。结果18例患者患侧喉肌电均有异常改变，主要表现为1～3个被检喉内肌肌电募集减弱。其中，甲杓肌肌电募集减弱现象见于所有病例；14例（77．8％）检测到失神经电位，均未发现神经再生电位；2例患者出现外展性联动。全部患者健侧喉肌电图均表现正常。结论喉肌电图可以为单侧喉麻痹的定性和定位诊断提供重要信息。本病喉肌电图的主要改变是受累喉内肌肌电募集减弱，多数伴有失神经电位，部分患者可出现喉内肌联动。     

失神经喉内肌纤颤电位波幅的变化及临床意义

目的 评估喉肌电图中纤颤电位波幅测定的临床应用价值。方法；对５４例（共６５侧）喉返神经麻痹患者的甲杓肌，环杓后肌行肌电图检查，记录最大纤颤电位波幅，结果：不同性别，年龄及不同侧的纤颤电位波幅间的差异无显著性，失神经环杓后肌纤颤电位波幅值均在病程２～－〈４个月时最高，而失神经甲杓肌纤颤电位波幅均值在病程４～－〈６个月时最高，相当一部分患者的纤颤电位波幅晚期仍维持一定水平，并且神经完全损伤者和不完全的     

正常喉肌电生理特点研究

目的研究正常喉肌电生理特点，了解其与喉功能的关系。方法对36例正常受试者行喉肌电图检查，包括喉肌运动单位肌电测量、喉肌肌电干扰相波幅-转折数分析，并分析喉肌肌电与喉功能的关系。结果(1)各喉肌几乎无完全电静息，平静时仍有少量肌电位发放，环杓后肌和杓间肌甚至多呈轻度和中度干扰相。(2)喉肌轻度、中度、高度收缩时喉肌募集增强，肌电发放率增加，波幅增大，其中甲杓肌、环甲肌和环杓后肌肌电波幅和转折数增大幅度相似，而环杓侧肌和杓间肌肌电转折数增大明显较波幅显著。(3)各喉肌肌电均在其相应喉功能活动前活跃或抑制。结论各喉肌正常运动单位电位及不同收缩力量干扰相波幅-转折数量化分析等参数的正常值不相同，与其各自的解剖生理特点相关；各喉肌共同协作完成喉的各种正常的功能活动，是一个统一的整体，缺一不可。     

正常喉肌电生理特点研究

目的:研究正常喉肌电生理特点,了解其与喉功能的关系。方法: 对36例正常受试者行喉肌电图检查,包括喉肌运动单位肌电测量、喉肌肌电干扰相波幅-转折数分析,并分析喉肌肌电与喉功能的关系。结果:(1)各喉肌几乎无完全电静息,平静时仍有少量肌电位发放,环杓后肌和杓间肌甚至多呈轻度和中度干扰相。(2)喉肌轻度、中度、高度收缩时喉肌募集增强,肌电发放率增加,波幅增大,其中甲杓肌、环甲肌和环杓后肌肌电波幅和转折数增大幅度形似,而环杓侧肌和杓间肌肌电转折数增大明显较波幅显著。(3)各喉肌肌电均在其相应喉功能活动前活跃或抑制。结论:各喉肌正常运动单位电位及不同收缩力量干扰相波幅-转折数量化分析等参数的正常值不相同,与其各自的解剖生理特点相关;各喉肌共同协作完成喉的各种正常的功能活动,是一个统一的整体,缺一不可。图3 表5参10     

喉返神经损伤后喉肌病理生理研究

目的：通过对犬喉返神经损伤及再生过程中喉肌电生理及其病理变化进行研究,探讨喉返神经不同损伤形式的病理生理改变及转归特点。方法：实验用犬20只（40侧）分为喉返神经完全损伤组（全切法）、不完全损伤组（结扎法、挫灭法、半切法）及对照组,造模成功后的即刻、1、3、6和12个月观察甲杓肌和环杓后肌肌电特征及组织病理学改变。结果：造模后即刻全切法及结扎法肌电为电静息,挫灭法和半切法存在部分正常单个运动单位（MUP）及振幅减小的MUP混合肌电。神经损伤后1～3个月可出现纤颤电位,不完全损伤组3～6个月出现再生电位。全切法诱发电位基本无法引出,结扎法和半切法早期无诱发电位,后期可以引出振幅减小的诱发电位,结扎法小于半切法;而挫灭法始终都可以引出诱发电位,振幅与对照组无显著性差异,诱发电位潜伏期呈现先延长后缩短的趋势。随着全切、结扎、半切、挫灭损伤程度不同,肌纤维平均直径及肌束直径逐渐增大,单位面积细胞核数逐渐减少。结论：不同损伤,肌电特征及声带运动状态呈动态变化,喉返神经的损伤程度依次为完全损伤、不完全损伤（结扎法、半切法、挫灭法）,喉肌电图检查是声带麻痹诊断和评估的重要方法。     

正常喉诱发电位特点的研究

目的 分析正常喉肌诱发电位特点,得出其参数正常参考值范围,以利于喉神经功能的评估.方法 检测36例健康受试者72侧喉诱发电位反应,刺激相应喉返神经、喉上神经内、外支及迷走神经,检测诱发肌电反应潜伏期、时程、波幅(电位).结果 甲杓肌喉返神经诱发肌电潜伏期正常参考值(-x±2s,以下同)为(1.13～2.25)ms,迷走神经诱发肌电潜伏期(2.57～5.85)ms,迷走神经与喉返神经潜伏期相比差异有统计学意义(P＜0.01);其中右侧迷走神经诱发肌电潜伏期(2.01～4.53)ms,左侧迷走神经(3.70～6.98)ms,双侧比较差异有统计学意义(P＜0.01),左侧明显较右侧长.诱发肌电时程和波幅各神经亦略有差异,时程差异较小,波幅值变化较大.刺激喉上神经(外支)在环甲肌可直接引出诱发电位,其波形和潜伏期与喉返神经诱发电位大致相同,刺激喉上神经(内支)在甲杓肌、环杓侧肌和环杓后肌可引出反射性感觉诱发电位前波R1和迟发波R2.结论 喉各支配神经诱发电位特点各不相同;神经诱发电位的潜伏期相对时程和波幅来说,是更重要的评估参数.     

声门闭合不全的喉肌电图和声门形态变化

目的：探讨声门闭合不全的原因、喉肌电图变化以及两者与声门形态变化的可能内在联系。方法：对24例声门闭合不全患者行喉镜及双侧环甲肌及环杓侧肌肌电图检测。结果：24例声门闭合不全患者中，仅6例为正常喉肌电图，其中声门呈梭形裂隙4例，三角形及矩形裂隙各1例；9例环甲肌出现纤颤电位，声门形态分别为梭形裂隙4例，矩形裂隙3例，三角形及半月形裂隙各1例；9例环杓侧出现纤颤电位，声门形态分别为俊形裂隙7例，三角形裂隙2例。结论：绝大多数声门闭合不全患者的原因不明，且存在喉上或／和喉返神经的不全麻痹。在原因不明、喉肌电图正常或环杓侧出现失神经电位等情况下，声门呈梭形裂隙者占绝大多数，而在某些诱因作用下或环甲肌出现失神经电位情况下发生的声门闭合不全，声门裂隙可表现为多种形态。     

喉肌电图对自发性或甲状腺切除术后喉固定的诊断

作者报道20例喉固定(喉返神经麻痹)患者的喉肌电图检查结果,5例甲状腺切除术后喉固定,15例自发性喉固定。局麻下用RaciaMS7型肌电记录仪及双极电极记录,针极经皮穿刺插入环甲肌,经皮和环甲膜穿刺插入声带肌(甲杓肌),经鼻纤维镜插入环杓后肌或侧肌,或在无箭毒中毒的神经安定药作用下经直接喉镜插入环杓后肌,以保存声带自主活动。20例喉固定患者肌电定位诊断结果有6种表现:①喉肌电正常,环杓关节强直或脱位;②     

长期失喉返神经支配患者环杓后肌GDNF及其受体GDNFR-α1变化的研究

目的探讨长期失喉返神经支配后,人环杓后肌胶质细胞源性神经营养因子(glial cell line-derived neurotrophic factor,GDNF)及其受体GDNFR-α1的变化规律。方法38例不同时限喉返神经损伤的患者,按神经损伤时限归入0.5~年、1~年、2~年、≥3年组,对照组12例,为因喉癌行喉全切除术且肿瘤未侵及环杓后肌者。采用免疫荧光双标记法分别标记GDNF和GDNFRα1,运用图像分析系统对环杓后肌GDNF和GDNFRα1表达变化进行评估。结果失神经0.5~年组、1~年组环杓后肌GDNF和GDNFR-α1表达的平均灰度值和阳性区百分比显著高于其他各组(P<0.001),失神经0.5~年组明显高于失神经1~年组(P<0.001)。对照组、失神经2~年组、失神经≥3年组之间无显著性差异(P>0.05)。结论失神经支配1年内环杓后肌GDNF和GDNFR-α1表达较高,失神经支配1~2年内环杓后肌GDNF和GDNFR-α1仍有表达,说明失神经支配2年以内喉肌GDNF的功能状态较好。     

DNA content in laryngeal keratosis, laryngeal cancer and normal laryngeal epithelium

The DNA content in laryngeal precancerous lesion, laryngeal keratosis, laryngeal carcinoma and normal laryngeal epithelium had been measured in order to study the relationship between histopathologic picture and DNA content. The results showed that the DNA content in keratotic tissue increased to varying degrees as compared with the normal tissue. The DNA content in laryngeal cancer increased distinctly, being much higher than that in normal and keratotic tissues.     

Three-dimensional laryngeal model for planning of laryngeal framework surgery

Conclusion. The three-dimensional prototype model was useful for planning of laryngeal framework surgery. Objective: To discuss the usefulness of a three-dimensional laryngeal model for laryngeal framework surgery. Materials and methods. A three-dimensional laryngeal model was created based on the postoperative helical computed tomography (CT) data of the larynx (case 1) which underwent lateral cricoarytenoid muscle (LCA) pull surgery. LCA pull surgery is a kind of arytenoid adduction for unilateral vocal cord paralysis. A three-dimensional model of case 1 larynx was prototyped using a selective laser sintering method. In case 1, the patient's voice did not improve after LCA pull surgery. The three-dimensional model revealed that the original surgical procedure was not appropriate to obtain optimal arytenoid adduction. According to the analysis of this three-dimensional model, we changed the surgical approach and performed this new refined LCA pull surgery on another patient with unilateral vocal cord paralysis (case 2). Results. We were able to pull LCA precisely in case 2. Three-dimensional CT of case 2 after refined LCA pull surgery allowed the correct pulling of LCA and complete adduction of arytenoid. The postoperative voice improved remarkably.     

Reflex control on laryngeal functions--vibration effect of the laryngeal mucosa on recurrent laryngeal nerve reflexes

Electromyographic (EMG) responses of the intrinsic laryngeal muscle have been investigated to clarify reflexogenic laryngeal controls from a viewpoint of its functional significance during phonation. Twenty-five adult cats were anesthetized with intraperitoneal injection of 4ml/kg of a mixture of 10% urethane and 1% alpha-chloralose. Either the internal branch of the superior laryngeal nerve (ISLN) or the recurrent laryngeal nerve (RLN) was carefully dissected and central end of the dissected nerve was electrically stimulated. EMG of the contra-lateral Thyro-Arytenoid muscle (TA muscle) to the stimulation was recorded using a hooked-wire electrode inserted through the laryngeal mucosa. EMG of the TA muscle evoked by the stimulation of the ISLN were analyzed with respect to its latency and discharge pattern inter-collicular brainstem transsected. Together with the stimulation of the RLN, vibratory stimuli were given mainly to the subglottic mucosa as conditioning stimuli. The vibratory frequency was changed from 50Hz to 400Hz step-wisely. Following results were obtained. 1. EMG response of the contra-lateral TA muscle to the stimulation of the ISLN showed two different kinds of latency, approximately 8-10msec, and 40-60msec. 2. After inter-collicular brainstem transsection, evoked response of the latter disappeared. This result indicates that the ISLN-RLN reflex loop consisted of more than two routes, different in the number of synaptic junctions. 3. The vibratory stimuli given to the laryngeal mucosa had facilitatory effect on the reflexive EMG response evoked by the stimulation of the RLN. 4. This facilitatory effect of the vibratory stimuli disappeared after topical anesthesia of the laryngeal mucosa. 5. The facilitatory effect on the reflex responses was partially increased depending on the vibratory frequencies applied. In conclusion, vibratory stimuli to the laryngeal mucosa reflexively modulate the activity of the intrinsic laryngeal muscles.     

保留功能的喉癌手术70例报告

目的 :探讨喉部分切除术治疗声门型、声门上型喉癌的远期疗效和功能恢复。方法 :对 1978年 7月～1998年 8月间手术的 70例临床资料进行总结和随访。其中声门型喉癌 6 0例、声门上型喉癌 10例 ;施行喉裂开声带切除术 2 2例 ,垂直半喉切除术 2 2例 ,Majer- Piquet手术 17例 ,水平半喉切除术 7例 ,Arslan手术 2例。结果 :1、3及 5年生存率分别为 98.5 3%、87.0 4%和 78.2 6 %。拔管率为 10 0 %。全部病例恢复经口进食 ,一经拔管均能发音。并发症发生率和术后复发率各为 15 .71%和 13.0 4%。结论 :喉部分切除术是功能保全性喉部恶性肿瘤根治的有效术式。它在切除肿瘤、延长生命的同时可以较好地保留喉的生理功能 ,提高患者术后的生活质量     

Three-dimensional laryngeal model for planning of laryngeal framework surgery

CONCLUSION: The three-dimensional prototype model was useful for planning of laryngeal framework surgery. OBJECTIVE: To discuss the usefulness of a three-dimensional laryngeal model for laryngeal framework surgery. MATERIALS AND METHODS: A three-dimensional laryngeal model was created based on the postoperative helical computed tomography (CT) data of the larynx (case 1) which underwent lateral cricoarytenoid muscle (LCA) pull surgery. LCA pull surgery is a kind of arytenoid adduction for unilateral vocal cord paralysis. A three-dimensional model of case 1 larynx was prototyped using a selective laser sintering method. In case 1, the patient's voice did not improve after LCA pull surgery. The three-dimensional model revealed that the original surgical procedure was not appropriate to obtain optimal arytenoid adduction. According to the analysis of this three-dimensional model, we changed the surgical approach and performed this new refined LCA pull surgery on another patient with unilateral vocal cord paralysis (case 2). RESULTS: We were able to pull LCA precisely in case 2. Three-dimensional CT of case 2 after refined LCA pull surgery allowed the correct pulling of LCA and complete adduction of arytenoid. The postoperative voice improved remarkably.     

Magnesium content of laryngeal precancerous conditions and laryngeal cancers

The content of magnesium in tissues, erythrocytes and serum was analysed by atomic absorption spectrometry. A higher concentration of magnesium was found in malignant laryngeal tissue and in lymph nodes of the neck compared to homologous pre-cancerous tissue. In pre-cancerous lesions of the larynx the magnesium concentration of the erythrocytes and serum lay at the lower limit of normal. In patients with cancer of the larynx, the magnesium concentration was considerably below the normal levels and continued to decline as the disease progressed.     

Spasmodic laryngeal dyspnea: a rare manifestation of laryngeal dystonia

We describe clinical experiences in the management of three patients with laryngopharyngeal dystonia causing severe breathing problems. In contrast to spasmodic dysphonia, which presents with action-induced involuntary spasms of laryngeal muscles during speaking, all three patients showed laryngopharyngeal spasms primarily during respiration. In analogy to spasmodic dysphonia we propose the term spasmodic laryngeal dyspnea for this rare condition. Localized unilateral botulinum toxin injected into the thyroarytenoid muscle and /or ventricular folds reduced the quantity and quality of spasms and led to a pronounced improvement of breathing problems.     

Recovery of laryngeal sensation after superior laryngeal nerve anastomosis.

OBJECTIVES/HYPOTHESIS: Reliable motor reinnervation has been show in multiple laryngeal transplant studies; however, sensory reinnervation of the larynx after nerve anastomosis has yet to be demonstrated. The role of sensory nerve anastomosis in the transplanted larynx in unknown, but is thought to be necessary to provide airway protection. A canine model was developed to examine the possibility of reformation of sensory pathways in the larynx after nerve section and anastomosis. STUDY DESIGN: Randomized controlled experiment. METHODS: Ten canines were randomly assigned to two groups. Hydrochloric acid-induced laryngospasm was demonstrated in every dog. All dogs then had their necks explored, and the internal branch of the superior laryngeal nerve was identified and transected bilaterally. Following nerve section all dogs were retested for an acid-induced laryngospasm reflex. The control group had their wounds closed and were then awakened from anesthesia. The study group underwent microscopic anastomosis of their sensory nerves. Following a 6-month period the two groups of dogs were compared for the presence of the laryngospasm reflex. RESULTS: No dog in the control group had a response to the acid. All dogs in the study group had some response to the acid, although none of them had return of true laryngospasm. CONCLUSION: We concluded that sensory reinnervation does occur after nerve anastomosis, but the recovery of sensation may be incomplete or altered.     

喉癌喉部分切除及喉功能重建

目的对189例喉部分切除,喉功能重建的喉癌患者的临床资料进行回顾性分析,并对各种术式和修复方法的疗效进行评价。方法对189例喉癌患者喉部分切除术后,同期采用颈前带状肌肌筋膜瓣、会厌瓣加双蒂肌筋膜瓣和舌骨肌瓣修复喉组织缺损,重建喉功能。47例颈淋巴结转移者同期行颈廓清术。结果所有患者术后10～15d进食。术后拔除气管套管114例,拔管率60.3%。23例发生术后感染,7例发生咽瘘。3、5年生存率分别为72%和65.6%。有颈淋巴结转移者生存率低于无转移者,未接受放疗者生存率低于术后放疗者,差异均有统计学意义(P<0.05)。结论依据喉癌发生的部位和累及范围选择不同的术式和修复方法,同期喉功能重建提高了患者的生活质量,值得推荐。