甲状腺术后单侧声带麻痹神经电刺激治疗的初步研究
Preliminary study on the treatment of unilateral vocal vord paralysis after thyroid surgery with neuroelectric stimulation
张慧慧 1侯瑾 1盛颖 1杜小滢 1孔德敏 1李娜 1任晓勇 1梁建民 1王正辉 1闫静1
作者信息
- 1. 西安交通大学第二附属医院耳鼻咽喉头颈外科,陕西 西安 710004
- 折叠
摘要
目的 回顾性分析甲状腺术后单侧声带麻痹患者接受选择性喉神经电刺激治疗的远期疗效,探讨喉神经电刺激在甲状腺术后单侧声带麻痹治疗中的作用.方法 选取2020年1月～2023年5月就诊于西安交通大学第二附属医院耳鼻咽喉头颈外科门诊,既往行甲状腺切除手术并经频闪喉镜及喉肌电图检查诊断为单侧声带麻痹的患者42例,病程为15 d～6年,喉肌电图检查时给予喉神经电刺激治疗,检查前后均完善频闪喉镜及主客观嗓音参数检查,并录音频保存,于治疗后1年进行随访,评估患者声嘶恢复情况.结果 电刺激治疗后,28例患者声嘶立刻改善,自觉发音费力明显缓解,且声门闭合较前改善,频闪喉镜下可观察到黏膜波.嗓音评分ΔR、ΔB、ΔH的改变有明显统计学差异(P<0.05).嗓音障碍严重指数(dysphonia severity index,DSI)较刺激前明显增高,差异有统计学意义;最长发音时间(maximum pronunciation time,MPT)较刺激前延长,但差异无统计学意义;基频微扰(Jitter)和振幅微扰(Shimmer)未见明显改变.电刺激治疗后1年随访,失访6例,随访36例,痊愈为58.3%(21/36),好转13.9%(5/36),未愈27.8%(10/36).电刺激治疗有效28例,失访2例,随访时痊愈19例,好转4例,有效率为88.5%(23/26).结论 喉神经电刺激治疗可以改善甲状腺术后单侧声带麻痹患者的声嘶,对其神经恢复期间的声音质量具有明显的改善作用.
Abstract
OBJECTIVE To retrospectively analyze the long-term efficacy of selective laryngeal nerve electrical stimulation for treatment of unilateral vocal cord paralysis after thyroid surgery,and to explore the role of laryngeal nerve electrical stimulation in the treatment of unilateral vocal cord paralysis after thyroid surgery.METHODS A total of 42 patients with unilateral vocal cord paralysis were selected from the Outpatient Department of Otolaryngology Head and Neck Surgery at the Second Affiliated Hospital of Xi'an Jiaotong University from January 2020 to May 2023.They had previously undergone thyroidectomy and were diagnosed with stroboscopic laryngoscopy and laryngeal electromyography.The course of the disease was 15 days to 6 years.During the examination of laryngeal electromyography,electrical stimulation of the laryngeal nerve was given.Both before and after the laryngeal electromyography,stroboscopic laryngoscopy,subjective and objective voice acoustics analysis(RBH,VHI,MPT,DSI)were completed.The voice was recorded and saved.Follow up will be conducted one year after treatment to evaluate the recovery of hoarseness in the patients.RESULTS After electrical stimulation therapy,28 cases showed immediate improvement in hoarseness,with significant relief ofdifficulty in pronunciation,and improved glottic closure compared to before treatment.Mucosal waves can be observed under strooscopic laryngoscopy.Changes in voice score of ΔR,ΔB,ΔH had a significant statistical difference,P<0.05.DSI significantly increased compared to that before stimulation,with statistical differences.MPT was prolonged compared to that before stimulation,but there was no significant statistical difference.Jitter and Shimmer did not show significant changes.During follow-up,6 patients were lost follow up,58.3%(21/36)of patients recovered,13.9%(5/36)patients improved,and 27.8%(10/36)patients did not improved.Among the 28 patients who received effective electrical stimulation therapy,19 recovered and 4 improved during follow-up,with a final effective rate of 88.5%(23/26).CONCLUSION This study indicates that laryngeal nerve electrical stimulation therapy can improve hoarseness in patients with unilateral vocal cord paralysis after thyroid surgery,and has a significant improvement effect on the voice quality during nerve recovery.
关键词
声带麻痹/经皮神经电刺激/外科手术/喉返神经/喉肌电图Key words
Vocal Cord Paralysis/Transcutaneous Electric Nerve Stimulation/Surgical Procedures,Operative/Recurrent Laryngeal Nerve/laryngeal electromyography引用本文复制引用
基金项目
陕西省自然科学基金青年项目(2024JC-YBQN-0889)
出版年
2024
国家科技期刊平台
NSTL
维普
万方数据