喉部分切除术后不同声源振动模式转换与代偿研究

目的研究喉部分切除术后喉的振动源变化及声带振动模式的代偿、转归,以探讨嗓音功能保留情况. 方法研究93例喉部分切除术患者(28例水平喉部分切除、35例垂直喉部分切除、30例3/4喉部分切除)及50例健康对照者不同嗓音声学、气流动力学及频闪喉镜下喉功能特点. 结果水平喉部分切除术后声带对称、表层肥厚,粘膜波活跃,嗓音声学参数与正常差异有显著性(P<0.05).垂直喉部分切除患者为非声门源振动发音,新振动体为健侧室带与对侧修复肌瓣或修复肌瓣与喉前庭粘膜(杓区、会厌根粘膜)振动发音,健侧声带未参与,嗓音声学参数与正常差异有极显著性(P<0.01).3/4喉部分切除后为部分非声门源振动发音,代偿振动模式为修复肌瓣与健侧声带振动发音和修复肌瓣与健侧杓区肥厚粘膜形成振动体颤动发音2种,嗓音声学参数与正常差异有显著性(P<0.01).3/4喉部分切除与垂直喉部分切除比较后者嗓音声学参数略差,但无统计学意义. 结论在喉部分切除术中,水平喉部分切除术后嗓音功能最佳,而垂直喉部分切除术后最差;修复体形态、功能特性直接影响术后效果.手术修复过程应充分利用机体的代偿功能,使术后声音质量有所提高.

Study on vibration mode of different phonatory source and compensation after par tial laryngectomy

Objective To investigate the nature of pathological voice production and compensatory mechanism after partial laryngectomy Methods Vocal function of 93 cases following partial laryngectomy (28 cases of horizontal partial laryngectomy, 35 vertical partial laryngectomy,30 horizontal vertical partial laryngectomy) were examined by acoustic analysis, aerodynamic analysis and videostroboscopic examination Results Horizontal supraglottic laryngectomy(HL) resulted in slight dysphonia after operation The cover of vocal fold was hypertrophic and edematous Mucosa wave was increased Acoustic analysis showed significant difference between normal and horizontal laryngectomy groups( P <0 05) Vertical laryngectomy(VL) resulted in moderate severe dysphonia Acoustic analysis was significantly worse in VL than in normal group( P <0 01) The nonglottic phonatory source was the contralateral ventricular fold or contralateral vestibular mucosa (arytenoid mucosa, root mucosa of glottis) to approximate the reconstructed flap It was noted that contralateral vocal fold did not participate in vibration Horizontal vertical partial laryngectomy(HVL) resulted in moderate severe dysphonia Acoustic analysis of HVL was significantly worse than that of normal phonation( P <0 01) The site of compensatory mucosa vibration upon phonation was the contralateral vocal fold or contralateral hypertrophic arytenoid mucosa The thinner the flap, the better the vocal quality was Vocal quality of VL was worse than that of HVL in regard to shimmer, jitter, normalized noise energy, maximal phonation time and harmonic noise ratio, but there was no significant difference between them Conclusions Partial laryngectomy has different vibrating compensatory modes: Voice function of horizontal partial laryngectomy was the best as it preserved the normal vibration mode; vertical partial laryngectomy was the worst with the nonglottic vibrating source of reconstructed flap ventricular fold The reconstructed flap, ventricular fold, mucosa of epiglottis and arytenoid take predominantly part in neoglottal vibration The situation, volume and pliability characteristic of reconstructed flap was also important to vocal quality