声带创伤性瘢痕的临床和病理研究

目的]研究声带创伤性瘢痕的临床和病理改变.方法]对27例创伤性声带瘢痕患者进行嗓音声学分析、动态喉镜观察,观察瘢痕的组织病理学改变,并设立对照组检查.结果]声带瘢痕组的基频、基频微扰、振幅微扰、声门噪声能量、谐噪比、最大发音时间与对照组比较均有统计学差异.频闪喉镜下瘢痕声带的黏膜波减弱(n=21)或消失(n=6);声带振动不规则,病变处声带振动消失,影响声门闭合.光镜下观察见瘢痕声带上皮部分缺失,存留的上皮层增厚,复层鳞状上皮的细胞层数增多;固有层增厚,大量胶原纤维增生,且排列紊乱,弹力纤维较少,紊乱散在分布于胶原纤维中,血管明显减少,管壁普遍增厚,腺体减少或消失;肌层中可见较多散在、紊乱的胶原纤维束.结论]瘢痕形成后声带的各层结构均受到损害,尤以黏膜上皮层和固有层改变明显,导致嗓音质量、声带振动功能受影响.

Clinical and Pathological Study of Traumatic Vocal Folds Scar

Objective The purpose of this study was to study the clinical and pathological changes of traumatic vocal folds scar. Methods A retrospective study was conducted in 27 pa-tients with traumatic vocal folds scar .The voice quality analysis of the patients were made objec-tively with Dr. Speech Software and vocal folds vibration were observed with stroboscope. The samples of scared vocal folds were observed pathologically with a light microscope. Results The fundamental frequency(F0),jitter,shimmer,normalized noise energy( NNE),harmonic to noise ratio(HNR) and maximum phonation time(MPT) of the patients were statistically worse than the controlled group. The mucous waves of the scared vocal fords weakened (n=21) or disappeared(n=6), the regularity and the periodicity worsened or disappeared under strobo-scope. Pathological study showed the epithelia were partially missed and the cells layers in-creased in scarred vocal folds. The lamina propria thickened. There were increased collagen fibers and decreased elastin fibers in the lamina propria where the fibers tangled and disorga-nized and formed some thick bundles. Blood vessels decreased with their walls thickened. Glands decreased or disappeared. There were some disorganized collagen fibers in the muscles. Conclusion The normal histologic structure was damaged in the traumatic vocal folds scar and caused worsened vibration function and voice quality.