喉良性增生性病变的嗓音学特点及治疗转归

目的 :探讨喉良性增生性病变对发声功能的影响及CO2 激光显微外科术后的转归特点。方法 :对2 92例喉良性增生性病变患者 (声带息肉、任克水肿、声带小结、囊肿、慢性肥厚性喉炎 )的流行病学、嗓音声学、形态及CO2 激光显微外科术后转归进行分析。结果 :声带小结患者均为青年女性 ,2 3.0 8%与职业有关 ;任克水肿为中老年患者。声带息肉及小结病变局限 ,手术仅涉及声带局部 ,术后改善明显 ,术后 1个月达正常状态 ;任克水肿患者术后 1个月改善明显 ,术后 3个月恢复最佳稳定 ;声带囊肿患者术后 1个月声音达最佳状态 ,但由于病变切除术后局部存在缺损 ,一定程度上影响预后 ;慢性肥厚性喉炎患者术后改善不满意。术后声门上代偿纠正均不明显。结论 :喉良性增生性病变主要累及声带被覆层 ,嗓音声障碍的程度及疗效与受累范围有关 ,激光显微外科手术可以保留良好结构及功能。除外科治疗外 ,还应及时矫正不良发声习惯等因素 ,以期获得最佳疗效。

Vocal function of benign vocal fold lesions and outcomes assessment after CO2 phonomicrosurgery

OBJECTIVE: To investigate the nature of benign vocal fold lesions and its outcomes assessment after CO2 phonomicrosurgery. METHOD: Vocal function of 292 cases of benign vocal fold lesions (vocal nodules, Reinke's edema, vocal fold cyst, vocal fold polyp and chronic laryngitis) and their outcomes assessment after CO2 phonomicrosurgery were evaluated. Vocal function was examined by acoustic analysis, aerodynamic analysis and videostroboscopic examination. RESULT: Young women with professional occupation were predominant in vocal nodules and the higher age showered in Reinke's edema. Vocal function of vocal nodules and vocal fold polyps had improved distinctly only one month after operation. For Reinke's edema, vocal function can recover three months after operation steadily. Although vocal function of vocal cyst also had improved distinctly only one month after operation, there was depression instead of cyst, the outcome of vocal quality would be affected by that. Vocal function of chronic laryngitis did not change so much after operation. However, ventricular dysphonia did not changed any more. CONCLUSION: Benign vocal fold lesion was located in the cover layer of the vocal fold. According to different lesions, the degree of voice disorder were differently. CO2 phonomicrosurgery can control the range of the operation and protect the cover layers delicately. Vocal function can recover three months after operation steadily. The localized lesions recovered only one month after operation. As the supraglottal hyperfunction remained post-operation, it is regarded as incorrect vocalization and effect on the prognosis.