自体筋膜移植填充治疗声带沟

目的探讨筋膜移植填充术在声带沟治疗中的价值及预后转归。方法23例双侧声带沟患者全麻显微镜下行声带沟瘢痕松解、筋膜移植填充手术，合并声带肌萎缩者同时行声门旁间隙脂肪注射。患者手术前、后行嗓音声学、气流动力学及频闪喉镜检查。结果4例手术失败者未进行疗效评价。19例术后6—8周患者发音开始改善，术后3个月发音改善明显。术后6个月音质趋于稳定，主、客观声学评价及气流动力学参数较术前改善明显，17例（89．5％）患者音质改善明显，声带结构及黏膜振动接近正常，声门闭合明显改善；2例患者音质改善不明显，声带形态接近正常，声门闭合改善，但黏膜振动不良。声音嘶哑主观评分与术前比较改善明显（P值均〈0．05），总评分2例患者（10．5％）提高2个等级，15例患者（79．0％）提高1个等级，2例患者（10．5％）评级无明显改变。除基频外，嗓音声学参数及最大发音时间与术前比较差异均有统计学意义（P值均〈0．01），8例（42．0％）患者声学参数达到正常范围，17例患者（89．5％）最大发音时间达到正常范围。19例患者随诊均6个月-1年，未发现筋膜吸收，其中5例患者随诊满2年，音质稳定。结论筋膜移植填充声带沟的手术可在一定程度上矫正声带固有层缺陷，改善声门闭合不良，恢复声带振动特性。

Autologous transplantation of fascia into the vocal fold for sulcus vocalis

Objective To evaluate the effects of vocal fold autologous fascia transplantation for treating sulcus vocalis. Methods Sulcus vocalis among 23 cases were dissected and vocal fold autologous fascia transplantation performed. For type III sulcus associated with thyroarytenoid muscle atrophy, autologous fat injection was carried out also. The voice acoustic quality and video laryngostroboscopic data were evaluated before and after surgery. Results Among 23 patients, 4 were excluded from the analysis because of failure of surgery or lost to follow-up, leaving a total of 19 patients who were included in the analysis. Until 6-8 weeks after surgery, patients could start to phonate. Vocal quality became better 3 months postoperatively. Vocal quality became steady 6 months after the surgery. Vocal improvement was obtained in 89. 5% (17/19) of the patients. The shapes, glottal closures and mucosal waves of vocal folds were improved. There was a significant decrease ( improvement) in scales of grading, roughness, breathiness, and asthenic after surgery (P < 0. 05 ) . For the grade parameter, it improved 2 scales in 2 patients (10. 5% ) and 1 scale in 15 patients (79. 0% ). Acoustic analysis and maximum phonation time ( MPT) were significantly improved after surgery ( P < 0. 01 ) . Acoustic parameters of 42. 0% ( 8/19 ) patients returned to normal range. MPT of 17 patients (89. 5% ) was in normal scopes. With 6 to 24 months follow-up, vocal function was steadily. There was no apparent reabsorption. Conclusions Autologous transplantation of fascia into the vocal fold was a useful and safe procedure for pathological sulcus vocalis.