Autologous fat granule filling combined with microsuture technique for sulcus vocalis
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摘要: 目的 探讨和观察支撑喉镜下声带沟切除、声带黏膜缝合囊袋制作以及脂肪粒填塞后的发声效果。方法 25例声带沟患者接受支撑喉镜下声带沟切除, 去除声带沟后, 将声带沟两侧黏膜进行显微缝合, 并缝合成一囊袋, 将腹部取出的脂肪粒填塞入囊袋直至声带边缘饱满, 整复黏膜, 再进行黏膜的缝合, 术后患者禁声2周, 术后3、6、12个月随访, 观察频闪喉镜下的声带黏膜状态以及声带的发声效果。观察指标主要为频闪喉镜黏膜的运动状态、基频(F0)、基频微扰(Jitter)、振幅微扰(Shimmer)、标准化噪声能量(NNE)、谐波噪声比(H/N)和最大发声时间(MPT)等。结果 25例患者中, 23例患者术后声带闭合良好、黏膜光滑, 频闪喉镜下见黏膜的运动状态良好、光滑, F0、Jitter、Shimmer、NNE、H/N和MPT较术前明显改善, 嗓音质量明显改善; 另外2例术后出现声带脂肪粒外溢, 经二次处理后好转, 嗓音功能得到很好的恢复。结论 支撑喉镜下声带沟切除、声带黏膜缝合以及脂肪粒填塞, 是治疗声带沟非常有效的办法。只要处理得当, 患者遵照医嘱禁声, 术后嗓音质量恢复效果满意。Abstract: Objective To explore and observe voice effect of the resection of the vocal fold sulcus, suture of the vocal fold mucosa, and fat granule packing under the support laryngoscope.Methods A total of 25 patients with vocal fold sulcus underwent vocal fold sulcus resection under a support laryngoscope. After the vocal fold sulcus was removed, the mucosa on both sides of the vocal fold sulcus was sutured into a pouch. Next the fat granules removed from the abdomen were stuffed into the pouch until the vocal folds were full, and the mucosa was repaired, and then the pouched mucosa was sutured. After the operation, the patients were silent for 2 weeks and followed up at 3, 6, and 12 months postoperatively to observe the state of the vocal fold mucosa and the voice effect of the vocal fold under the stroboscopic laryngoscopy. The main outcome measures were the mucosal movement, fundamental frequency (F0), fundamental frequency perturbation (Jitter), amplitude perturbation (Shimmer), normalized noise energy (NNE), harmony/noise (H/N) and maximum phonation time (MPT).Results Among the 25 patients, 23 patients had good vocal fold closure and smooth mucosa. Under the stroboscopic laryngoscope, the mucosal movement was good and smooth, and the F0, Jitter, Shimmer, NNE, H/N, MPT were significantly improved, and the voice quality was significantly improved. The other 2 patients had fat particles spillover in the vocal fold. The voice function recovered well after the second treatment.Conclusion Resection of vocal fold sulcus, suture of vocal fold mucosa, and fat granule packing under support laryngoscope are very effective for the treatment of vocal fold sulcus. Indispensably, the operation is done properly, and the patient silence the voice according to the doctor's advice, thus the voice quality will be satisfactory after the operation.
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Key words:
- sulcus vocalis /
- pouch /
- microsuture technique /
- fat granule /
- voice
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表 1 声带沟治疗前后患者嗓音主观感知评估对比
分，x±s 评估时间 例数 嘶哑总评分 粗糙声 气息声 弱音 术前 23 2.7±0.4 2.5±0.6 2.4±0.7 0.4±0.2 术后12个月 23 1.3±0.7 1.4±0.2 1.2±0.5 0.0±0.1 t 12.62 11.82 12.42 4.58 P ＜0.01 ＜0.01 ＜0.01 ＜0.01 
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表 2 声带沟治疗前后患者嗓音声学及气流动力学参数对比
x±s 检测时间 例数 F0/Hz Jitter/% Shimmer/% NNE/dB 谐噪比/dB MPT/s 术前 23 280±48.3 2.8±2.1 8.6±1.9 -1.9±1.7 10.8±3.0 7.9±4.2 术后12个月 23 258±68.2 0.6±0.7 3.7±2.0 -8.5±6.0 17.4±4.5 16.0±6.0 t 2.95 10.04 4.87 4.71 3.45 -5.73 P 0.51 ＜0.01 ＜0.01 ＜0.01 ＜0.01 ＜0.01
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