支撑喉镜下CO2激光切除声带息肉和声带白斑疗效分析

目的 比较CO2激光与喉显微手术切除声带息肉和声带白斑的疗效。方法 60例声带息肉患者随机分成两组,每组30例;30例声带白斑患者随机分成两组,每组15例。两类患者均一组采用支撑喉镜下显微手术(常规组),另一组采用支撑喉镜下CO2激光切除病变组织或粘膜剥脱术(激光组)。两组患者分别于术前、术后1周、1月及3月行频闪喉镜、电子喉镜检查,GRABS、VHI主观评分及客观嗓音分析。结果 声带息肉患者术后1周激光组患者声带恢复情况略差于常规组,术后1~3个月,电子喉镜检查、频闪喉镜黏膜波观察及嗓音主客观分析,两组差异均无统计学意义。声带白斑患者术后1周激光组声带创面恢复略差于常规组,术后1~3个月,两组间电子喉镜检查、频闪喉镜黏膜波观察及主客观嗓音分析差异无统计学意义,术后随访1~4年,激光组复发率(6.67%,1/15)明显低于常规组(20%,3/15)。结论 CO2激光喉显微手术治疗声带息肉和声带白斑患者均疗效好,尤其是治疗声带白斑的远期疗效优于常规手术。     

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。     

CO2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、噪音声学分析、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；激光组术后的噪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，术后噪音恢复快，同时也减轻了患者的经济负担。     

声带息肉合并喉梗阻症状的治疗方法探讨

目的　研究喉显微镜支撑喉镜下CO2激光手术治疗声带息肉合并不同程度喉梗阻患者的疗效。方法　选取18例声带息肉伴有不同程度喉梗阻患者为研究对象,均采用纤维支气管镜引导下经鼻气管插管,实施喉显微镜支撑喉镜下CO2激光切除声带息肉手术,术后1个月复查电子喉镜,统计患者治疗总有效率及嗓音功能恢复、并发症以及术后复发等情况。结果　18例患者均一次性插管成功,无气管切开病例,除2例口咽侧壁擦伤外无其他并发症,术后呼吸困难症状改善明显,术后1个月嗓音功能恢复良好, 治愈14例（77.78%）,好转4例（22.22%）,随访半年,无复发病例。结论　纤维支气管镜引导下经鼻气管插管,CO2激光显微外科手术是治疗声带息肉合并喉梗阻患者安全、有效、微创的手术方法,值得临床推广应用。     

支撑喉镜下声带白斑的手术治疗及预后分析

目的分析声带白斑临床因素对预后的影响，比较CO2激光与喉显微手术切除声带白斑的疗效。方法回顾性分析2010年1月～2012年12月收治的60例声带白斑患者的临床资料。分析患者性别、年龄、吸烟、饮酒、胃食管反流、手术方式与声带白斑预后的关系。按数字随机法将患者分成常规组30例，激光组30例。常规组患者采用支撑喉镜下冷器械喉显微手术，激光组采用支撑喉镜下CO2激光切除声带白斑病变组织。常规组和激光组患者均在术前1周，术后1周、1个月和3个月分别行电子喉镜、频闪喉镜检查、GRBAS、VHI主观评分和客观嗓音分析。结果60例声带白斑患者中，长期吸烟51例（85.00％），长期饮酒49例（81.67％），伴胃食管反流35例（58.33％）。多因素分析表明，患者的性别、年龄、吸烟、饮酒和胃食管返流在声带白斑的复发和声带白斑恶变的影响差异均无统计学意义（Ｐ＞0.05）。研究结果显示，术后1周声带白斑激光组的声带伤口恢复略好于常规组术后1周患者。而激光组和常规组患者电子喉镜检查、频闪喉镜黏膜波观察和主客观嗓音分析在术后1～3个月结果统计分析差异无统计学意义（P>0.05）。激光组和常规组患者，在术后1～4年进行随访，随访的结果是常规组的复发率明显高于激光组复发率（6.67％，2/30）。结论声带白斑发病与吸烟、饮酒、胃食管反流相关，但在其复发及恶变影响方面无统计学意义（P>0.05）。常规组近期效果较激光组稍好，但声带白斑治疗的远期效果CO2激光喉显微手术疗效优于常规手术。     

48例双侧广基型声带息肉患者不同术式疗效的主客观评估

目的:探讨CO2激光和CO2激光联合显微缝合术治疗双侧广基型声带息肉的疗效.方法:将48例双侧广基型声带息肉患者随机分为CO2激光组和CO2激光＋显微缝合组,结合主观评分及客观嗓音分析评估术后两组患者的手术效果以及疗效差异.结果:两组患者术后1个月和3个月基频微扰(Jitter)、振幅微扰(Shimmer)、嗓音障碍严...     

嗓音声学分析在声带息肉术式的选择及治疗中的应用

摘要：目的比较支撑喉镜下喉显微手术与电子纤维喉镜下YAG激光手术治疗不同类型声带息肉的疗效。方法146例声带息肉患者随机分成两组,其中一组门诊行电子纤维喉镜下YAG激光手术62例,另一组支撑喉镜下显微切除术84例;采用Dr.Speech软件获得两组患者术前1 d、术后1周及术后2周的嗓音基频微扰（jitter）、振幅微扰（shimmer）及嗓音障碍严重指数（dysphonia severity index, DSI）的数值。对嗓音声学参数行统计学分析。结果声带息肉患者术前1 d的基频微扰（jitter）、振幅微扰（shimmer）均高于正常组而DSI偏低,差异均具有统计学意义（P<0.05）;两组患者术后1周及术后2周较术前明显好转;电子喉镜下YAG激光手术与支持喉镜下显微手术处理简单型声带息肉,术后同时段比较差异无明显统计学意义（P>0.05）;支持喉镜下显微手术处理复杂型声带息肉效果优于电子喉镜下YAG激光手术,同时段比较差异均具有统计学意义（P<0.05）;而术后2周与正常对照组比较差异无统计学意义（P>0.05）。结论电子喉镜与支持喉镜处理简单型声带息肉效果相当,处理复杂型声带息肉支持喉镜下显微手术效果更佳。     

早期声门型喉癌患者CO2激光治疗后嗓音功能评估

目的通过主观及客观评估分析早期声门型喉癌患者喉内镜下CO2激光治疗后嗓音功能恢复情况。方法回顾性分析1999年10月至2005年10月接受CO2激光手术治疗的112例声门型喉癌(Tis15例、T1a53例、T1b15例、T229例)患者的术后疗效及嗓音恢复情况,于术后6个月对103例局部无复发及4例复发后行二次激光手术后6个月的患者进行嗓音障碍指数(voice handicap index,VHI)评估表自我评分及嗓音客观评估,包括:嗓音声学分析、电声门图、最长发声时间测试;其中85名患者完成VHI问卷调查。选择50例健康男性作为正常对照组。全部病例于术后6个月进行频闪喉镜检查。声带切除方式按2000年欧洲喉科学会制定分类方案划分为5型,对比组间差异,并与正常对照组比较。结果依照Kaplan-Meier方法计算5年整体生存率为90.24%。声带上皮下切除组、声韧带下切除组与对照组嗓音参数比较,差异无统计学意义(P>0.05),VHI得分均显示正常或轻度嗓音障碍。而经肌肉声带切除组、声带完全切除组及扩大声带切除组与对照组嗓音参数比较,差异有统计学意义(P<0.05),51.8%的患者VHI分值处于中至重度嗓音障碍。结论CO2激光外科治疗早期声门型喉癌疗效确切,可较好保全喉发声功能。其中声带上皮下切除(Ⅰ型)及声韧带下切除(Ⅱ型)术后可恢复近乎正常的嗓音。     

阿克森疗法对声带息肉术后嗓音功能恢复的主客观评估

目的评估阿克森疗法促进声带息肉术后患者嗓音功能恢复过程的效果。方法支撑喉镜下显微手术切除声带息肉并经病理组织学确诊的患者60例,随机分为2组,每组30例。治疗组患者术后在常规护理及术后处理基础上加行阿克森疗法3月以促进嗓音恢复治疗,对照组患者在术后仅行常规护理及术后处理,随访观察1年;随访期结束时,均行嗓音障碍指数(VHI)、GRBAS、最大发音时间(MPT)检查,分别从主、客观角度对比分析2组患者术后嗓音功能恢复程度。结果随访结束时,有完整嗓音资料的治疗组患者18例,对照组患者20例。3种主客观评估方法评估结果显示,二组术后1年时的有效率差异均有统计学意义(P0.05)。结论阿克森疗法对声带息肉术后嗓音功能恢复具有确切效果;嗓音障碍指数、最大声时和GRBAS评估系统能同时进行嗓音功能恢复水平的主观及客观评估。     

喉显微激光术后声带粘连的治疗和预防

目的　探讨内镜下喉内置入非聚氯乙烯（polyvinyl chloride，PVC）喉膜治疗和预防双侧声带粘连的临床疗效。方法　收集2013年1月～2017年9月在我科行CO2激光喉显微手术后喉腔置入非PVC喉膜治疗和预防声带粘连的25例患者临床资料，其中16例（治疗组）双侧声带病变术后4～13个月声带粘连患者（严重程度为II～Ⅳ级，均未累及声门下），行CO2激光分离粘连后喉外法喉膜置入；9例（预防组）前连合病变和累及前连合的双侧声带病变患者，行CO2激光切除病变，术中喉外法同期行喉膜置入 预防术后声带粘连或喉狭窄。上述25例患者术前术后均行主观嗓音质量评估。术后4周左右取出喉膜，至少随访12个月，观察术后声门形态及临床疗效。结果　治疗组16例患者中，有效13例（81.25%），无效3例（18.75%）。预防组9例一期喉膜置入预防声带粘连患者中，有效6例（66.67%），无效3例（33.33%）。治疗组术后嗓音障碍指数较术前明显改善（P <0.01），两组术后均无明显并发症。结论　内镜下喉外法喉内植入非PVC喉膜是治疗和预防声带粘连的有效方法，值得推广应用。     

CO2激光显微手术与传统显微手术切除声带息肉疗效比较

目的 比较显微镜CO₂激光机下与传统显微镜支撑喉镜下切除声带息肉的疗效及恢复情况。 方法 选择2013年5月至2016年9月就诊的214例声带息肉患者,按照病理情况和治疗方法不同分为四组,分别为普通CO₂激光组50例,普通传统显微镜组56例,复杂CO₂激光组48例,复杂传统显微镜组60例,比较两种手术方法治疗不同病理情况患者的嗓音疗效。 结果 四组患者总体疗效比较,差异无统计学意义(P > 0.05)。术后普通型和复杂型声带息肉患者通过两种手术方式治疗总有效率、基频、基频微扰、振幅微扰、噪声能量、谐噪比比较均无统计学差异(P > 0.05)。 结论 显微镜CO₂激光手术与传统显微镜支持喉镜手术治疗声带息肉均能取得较为满意效果,需根据患者具体病情选择最佳治疗方案、优化手术及术后恢复。     

CO2激光喉显微外科技术治疗喉良恶性病变

目的回顾分析应用CO2激光喉显微外科技术治疗喉部良恶性病变的效果。方法自1999年1月1日至2003年6月30日，应用CO2激光喉显微外科技术治疗喉部良恶性病变313例，其中采用切割或汽化方法切除声带息肉236例，声带小结30例；采用声带黏膜剥脱术切除声带白斑、声带角化症、声带不典型增生27例；应用声带黏膜剥脱术或声带切除术切除声门型喉癌(T1aN0M0％)20例。结果所有患者均一次切除病变，术中出血少或不出血，术野清楚。术后无一例出现呼吸困难、出血等严重并发症。声带息肉和声带小结患者的有效率达100％；声带白斑、角化症、不典型增生患者的有效率为92．6％；声门型喉癌患者半年复发率10％。结论应用CO2激光进行喉显微外科手术术中出血少、术野清楚，有效率高，拓展了手术的适应证和范围，值得推广应用。     

喉CO_2激光手术后声带粘连原因分析

目的:分析CO2激光手术治疗喉部疾病引起声带粘连的原因。方法:回顾性分析显微支撑喉镜下行喉部激光手术119例的临床资料。结果:119例患者中,双侧声带外展麻痹9例,声带息肉42例,喉癌前病变3例激光手术后均未引起声带粘连;喉狭窄5例中有1例,喉乳头状瘤41例中有5例,喉癌19例中有6例激光手术后出现声带粘连。结论:CO2激光手术通过选择合适的患者及手术部位,完善术中术后的处理,采用适宜的激光照射剂量,减少热辐射,可减少或避免显微喉镜激光手术引起的声带粘连。     

Quality-of-life outcomes following laryngeal endoscopic surgery for non-neoplastic vocal fold lesions

Preservation of the vocal fold cover during laryngeal surgery should optimize vocal outcomes for patients with benign glottal lesions. The aim of this study was to evaluate changes in the quality of life, perceptual voice evaluation, and acoustic and aerodynamic measures of patients before and after endoscopic laryngeal microsurgery for true vocal fold cysts, polyps, and scarring. Preoperative and postoperative Voice Handicap Index (VHI) scores, Short Form 36 scores, and perceptual, acoustic, and aerodynamic voice measures were obtained prospectively from 42 patients who underwent phonomicrosurgery from February 2000 through May 2003. The mean (+/-SD) preoperative VHI was 49.6 +/- 21. The mean postoperative VHI score at a minimum of 3 months after surgery decreased to 26.8 +/- 21 (p < .001). When divided by lesion type, VHI scores improved significantly after surgery for vocal fold polyps and cysts. Although patients with vocal fold scarring demonstrated improvement in VHI scores after surgery, statistical significance was not achieved. For the entire group, the Short Form 36 scores were not significantly different from US norms either before or after operation. The acoustic data showed statistically significant decreases in jitter (2.05% to 1.26%), shimmer (7.06% to 4.03%), and noise-to-harmonics ratio (0.18 to 0.13) after surgery (p < .05) in female patients. The upper pitch limit increased after surgery in women (495.3 Hz to 654.9 Hz, p < .001). These results indicate that the voice-related quality of life and some acoustic parameters improve significantly for patients who have undergone laryngeal microsurgery for vocal fold cysts and polyps. Vocal fold scarring remains a difficult clinical problem with less favorable outcomes following surgical treatment in this patient set.     

Our experience in CO2 laser surgery for early glottic carcinoma

In the years 1990-2002 187 patients were treated laser microsurgery due to T1, T2 laryngeal cancer. One of the purposes of this work was analysis of resurgery cases due to recurrence of neoplasmatic process after laser cordectomy, therefore a group of 93 patients, treated in the years 1990-1997 was controlled. The local recurrence of neoplasmatic process was observed in 13 persons. The changes were once more removed in laser microsurgery in 5 patients. In 8 persons total laryngectomy was performed with subsequent radiological treatment. The best results of treatment were observed in patients in whom changes were limited to medial part of vocal cord while recurrences were the most often in patients with anterior commissure lesion. In case of recurrences after laser microsurgery all other kinds of possible treatment can be applied as, partial conventional surgery, total laryngectomy, X-ray therapy or repeated laser microsurgery. Functional evaluation of voice in 64 patients, who due to early stage of carcinoma were submitted unilateral CO2 laser cordectomy, was performed. The appearance and mobility of larynx were registered and evaluated in particular periods post surgery, the patients voices were registered and acoustic analysis submitted. Gradual voice improvement following the wound healing were observed in subjective patients evaluation as in objective one. In many cases very good functional results were obtained, which made possible for patients after CO2 laser cordectomy to continue work requiring good function of larynx. In 43 patients the psychological aspect of laser microsurgery influence was analyzed by use of anonymous questionnaires. It proofed, that in the majority of cases, the laser surgery had no influence for the social and company life of people submitted laser cordectomy. In 7 patients the views of larynx were very specific on the free edge of scar after removed vocal cord--spherical structure of 3-5 mm diameter has appeared in 2 to 6 months after laser cordectomy. In pathological examination--laryngitis chronica, granulatio--was stated. In further observation of patients no recurrences were observed. The described changes resemble granulomas and the most probably are caused by laser ray. Higher power lasers are useful, even when used at the same wattage as older models as they produce less carbonization of tissue during use.     

显微缝合技术治疗声带任克水肿患者的嗓音评估

目的：采用嗓音主客观评估方法对手术中应用显微缝合技术治疗声带任克水肿的患者进行嗓音评估。方法：选择经手术治疗的20例声带任克水肿患者，均采用全身麻醉支撑喉镜显微镜下外侧微瓣技术切除病变，保留声带表面部分的正常黏膜，应用显微缝合技术将黏膜对位间断缝合。对所有患者分别进行术前和术后2周、3个月、6个月的嗓音评估，嗓音评估的结果与20例（男性）正常嗓音对照，评估采用显微缝合技术的声带愈合时间和嗓音恢复程度。结果：术后2周时双声带充血，声带振动幅度及黏膜波轻度减低，患者嗓音质量与术前相比明显改善（P〈0．05）；术后3个月时声带形态基本恢复正常，声带振动幅度及黏膜波正常，患者嗓音质量与术前相比明显改善（P〈0．05），与正常对照组比较差异无统计学意义（P〉0．05）；术后6个月时，嗓音质量保持稳定，与术后3个月比较无明显差异（尸〉O．05）。结论：采用显微缝合技术治疗声带任克水肿，术后恢复时间短，术后3个月时嗓音质量基本恢复正常。     

Benign lesions of the larynx: Should the laser be used?

The use of the carbon dioxide (CO2) laser in the treatment of patients with benign laryngeal lesions, excluding respiratory papillomatosis, has been questioned because of potential adverse thermal effects on surrounding tissue. We question whether wound healing and subsequent quality of voice would be better if the surgeon used the "cold technique" with microlaryngeal instruments. Since the advent, in 1987, of a small-spot (0.3 mm) CO2 laser micromanipulator and more precise microlaryngeal instruments, we have redefined our use of the CO2 laser for benign laryngeal lesions. Over the past 4 years, in a series of 68 consecutive patients with vocal cord nodules, polyps, polypoid changes, or granulomas, the CO2 laser was useful for mucosal micro-flap dissection techniques and for vascular lesions. Smaller pedunculated lesions, such as vocal cord nodules, were more efficiently removed with the new microlaryngeal instrumentation. The combined selective use of a microspot CO2 laser at low-power settings (1 to 3 W), with 0.1-second pulses, and with precise microlaryngeal instruments will give the best results.     

纤维喉镜下半导体激光治疗喉肿物30例

目的 探讨半导体激光治疗包括声带良性肿瘤、癌前病变等在内的喉肿物优点, 分析疗效。方法 表面麻醉, 在纤维喉镜引导下利用半导体激光切除声带或者喉室小结、息肉及声带白斑、乳头状瘤等喉肿物。术后采用口服药物或者雾化治疗消除手术水肿, 禁声1个月, 吸烟患者强制戒烟。结果 1个月后患者声嘶症状基本解决, 声带黏膜恢复良好。结论 纤维喉镜引导下半导体激光治疗喉肿物疗效好, 患者花费少, 痛苦小。