Analysis of vocal characteristics in hypopharyngeal cancer patients with vocal cord dysfunction
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摘要: 目的 分析伴有声带活动障碍的下咽癌患者其嗓音学特征。 方法 回顾性分析2018年1月至2024年4月于西安交通大学第二附属医院初治的下咽癌患者的资料，从中筛选出完成电子喉镜检查、频闪喉镜检查和嗓音分析者，其中存在病变侧声带活动障碍的下咽癌患者设为试验组；而双侧声带活动对称、无声带活动障碍者设为对照组。分析比较试验组和对照组的下咽癌患者其临床基本特征、嗓音学参数及频闪喉镜检查结果。 结果 与对照组比较，试验组患者其病变位于梨状窝内侧壁的比例显著增高(83.3% vs 53.8%，P＜0.05)。试验组与对照组患者比较，其嗓音学参数如声压级(SPL)、基频微扰(Jitter)、振幅微扰(Shimmer)、最长发音时间(MPT)、嗓音障碍指数(DSI)、基频(F0)、声强、嗓音障碍指数量表(VHI)等比较均差异无统计学意义(P>0.05)，但试验组F0、Jitter、Shimmer、VHI值均高于对照组。另外，从频闪喉镜检查结果看，试验组其声门闭合不全(42.9% vs 18.8%)、杓状软骨不对称的患者比例(64.3% vs 0)均显著高于对照组(P＜0.05)，但试验组和对照组患者均无病变侧的声带黏膜波减弱。试验组接受诱导化疗(尼妥珠单抗+奈达铂+5-氟尿嘧啶)的18例患者，13例声带活动度改善，改善率为72.2%。 结论 下咽癌尤其是梨状窝内侧壁癌更易出现声带活动障碍，但声带活动障碍对下咽癌患者的嗓音学参数影响不明显。Abstract: Objective To analyze the acoustic characteristics of patients with hypopharyngeal cancer accompanied by vocal cord dysfunction. Methods A retrospective analysis was conducted on the data of patients with hypopharyngeal cancer who were initially treated at The Second Affiliated Hospital of Xi'an Jiaotong University from January 2018 to April 2024. Patients who had completed electronic laryngoscopy, stroboscopic laryngoscopy, and voice analysis were selected from the data. Among them, patients with hypopharyngeal cancer who had unilateral vocal cord activity disorders were selected as the experimental group, while patients with symmetrical bilateral vocal cord activity were assigned to the control group. Then the clinical characteristics, the vocal parameters, and the stroboscopic laryngoscopy results of patients with hypopharyngeal cancer in the experimental group and the control group were analyzed and compared. Results Compared with that in the control group, the proportion of lesions located on the inner wall of the piriform fossa in the experimental group increased(83.3% vs 53.8%), and the difference was statistically significant(P < 0.05). There was no significant difference in vocal parameters such as SPL, Jitter, Shimmer, MPT, DSI, F0, sound intensity, electroglottic value and VHI between the experimental group and the control group(P>0.05). However, the values of F0, Jitter, Shimmer and VHI in the experimental group were higher than those in the control group. In addition, in terms of the results of stroboscopic laryngoscopy, the proportion of glottic insufficiency(42.9% vs 18.8%) and asymmetric arytenoid cartilage(64.3% vs 0) in the experimental group was significantly higher than that in the control group(P < 0.05). However, the mucosal waves of the vocal cords on the affected side did not weaken in patients in both the experimental group and the control group. In the experimental group of 18 patients with hypopharyngeal cancer who received induction chemotherapy(nituzumab+nedaplatin+5-fluorouracil), 13 of them had improved vocal cord activity(improvement rate of 72.2%). Conclusion Hypopharyngeal cancer in the medial wall of the pyriform fossa is more prone to vocal cord dysfunction, but vocal cord dysfunction has little effect on the vocal parameters of patients with hypopharyngeal cancer.
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表 1 试验组与对照组的下咽癌患者临床资料比较
X±S 指标 试验组(n=24) 对照组(n=26) t P 男︰女/例 22︰2 25︰1 - - 年龄/岁 68.36±2.70 62.88±2.73 -1.420 0.167 病程/月 4.69±0.90 7.20±3.60 -0.609 0.543 中性粒细胞计数/(×109/L) 3.96±0.35 3.89±0.55 -0.291 0.771 白细胞计数/(×109/L) 6.14±0.39 6.31±0.55 -0.353 0.724 红细胞计数/(×1012/L) 4.23±0.24 4.48±0.12 0.961 0.345 血红蛋白计数/(g/L) 136.28±4.12 145.31±3.81 1.612 0.118 血小板计数/(×109/L) 206.07±16.09 191.06±14.33 -0.699 0.490 
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表 2 试验组与对照组的下咽癌患者嗓音学参数比较
X±S 指标 试验组(n=24) 对照组(n=26) t P SPL/dB 74.36±1.75 77.13±1.14 1.355 0.186 Jitter/% 1.41±0.50 0.88±0.06 -1.111 0.276 Shimmer/% 3.27±0.45 2.85±0.21 -0.878 0.387 MPT/s 17.33±2.39 18.51±2.21 0.363 0.719 DSI -1.26±1.30 1.33±0.62 1.877 0.071 F0/Hz 172.00±37.83 152.50±9.12 0.790 0.429 声强/dB 77.50±1.00 76.00±1.02 -1.047 0.304 VHI 32.32±10.22 16.88±5.09 1.517 0.146
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[1] Zhang D, Li LX. Risk factors and prognostic models of lymph node metastatic hypopharyngeal squamous cell carcinoma[J]. Eur Arch Oto Rhino Laryngol, 2023, 280(11): 5019-5029. doi: 10.1007/s00405-023-08077-8
[2] Lin TY, Lee TL, Hsu YB, et al. Survival analyses of different treatment modalities and clinical stage for hypopharyngeal carcinoma[J]. Front Oncol, 2023, 13: 1109417. doi: 10.3389/fonc.2023.1109417
[3] Xu SY, Huang Y, Huang H, et al. Organ preservation surgery for pyriform sinus carcinoma with vocal cord fixation: functional and oncological outcomes[J]. Eur Arch Oto Rhino Laryngol, 2022, 279(7): 3611-3617. doi: 10.1007/s00405-021-07182-w
[4] Rao VUS, Majumdar KS, Subash A, et al. Prognostic significance of vocal cord mobility after laryngeal preservation protocols in locally advanced laryngopharyngeal cancers: a retrospective analysis[J]. Indian J Otolaryngol Head Neck Surg, 2021, 73(2): 207-211. doi: 10.1007/s12070-020-02306-w
[5] Villani FP, Paderno A, Fiorentino MC, et al. Classifying vocal folds fixation from endoscopic videos with machine learning[J]. Annu Int Conf IEEE Eng Med Biol Soc, 2023, 2023: 1-4.
[6] Succo G, Cirillo S, Bertotto I, et al. Arytenoid fixation in laryngeal cancer: radiological pictures and clinical correlations with respect to conservative treatments[J]. Cancers, 2019, 11(3): 360. doi: 10.3390/cancers11030360
[7] He YQ, Zhang XW, Zhu YM, et al. Posttreatment non-improved vocal cord mobility indicates the need of salvage surgery for hypopharyngeal carcinomas[J]. Front Oncol, 2020, 10: 600599.
[8] 李晓晓. 与梨状窝瘘喉内手术径路相关的临床解剖学研究[D]. 郑州: 郑州大学, 2017.
[9] Wang L, Liu DY, Sun RJ, et al. Therapeutic effect on pyriform sinus carcinoma resection via paraglottic space approach[J]. Front Surg, 2023, 9: 1068754. doi: 10.3389/fsurg.2022.1068754
[10] 刘文中, 费声重, 李树春, 等. 梨状窝癌致半喉固定的机理及其意义[J]. 中华耳鼻咽喉科杂志, 1997, 32(3): 135-138.
[11] 刘文中, 费声重, 李树春. 梨状窝癌的病理学研究现状[J]. 国外医学耳鼻咽喉科学分册, 1996, 20(1): 26-30.
[12] 陈彦林, 单希征, 李钦. 伴有声带运动障碍的下咽癌手术[J]. 中华耳鼻咽喉头颈外科杂志, 2011, 46(3): 234-236. doi: 10.3760/cma.j.issn.1673-0860.2011.03.014
[13] 王晓雨, 魏梅, 林鹏, 等. 单侧声带麻痹患者发声功能损害的客观特征及在言语治疗中的应用[J]. 中华耳鼻咽喉头颈外科杂志, 2019, 54(9): 685-688. doi: 10.3760/cma.j.issn.1673-0860.2019.09.007
[14] 李娟, 徐文, 程丽宇. 频闪喉镜及窄带成像内镜在声带白斑诊断中的应用[J]. 中华耳鼻咽喉头颈外科杂志, 2017, 52(11): 806-811. doi: 10.3760/cma.j.issn.1673-0860.2017.11.002
[15] Heyduck A, Brosch S, Pickhard A, et al. The efficiency of(videolaryngo)stroboscopy in detecting T1a glottic carcinoma and its preliminary stages[J]. Ann Otol Rhinol Laryngol, 2022, 131(5): 471-477. doi: 10.1177/00034894211026732
[16] 虞鹏程, 高楠, 李旭茂, 等. 喉肌电图在声带麻痹与环杓关节脱位疾病中的鉴别价值[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(6): 420-423. https://lceh.whuhzzs.com/article/doi/10.13201/j.issn.1001-1781.2018.06.006
[17] Mathias Aaen, McGlashan J, Sadolin C. Investigating laryngeal"tilt"on same-pitch phonation-preliminary findings of vocal mode metal and density parameters as alternatives to cricothyroid-thyroarytenoid "mix"[J]. J Voice, 2019, 33(5): 806. e9-806806. e21. doi: 10.1016/j.jvoice.2018.02.023
[18] 陈仁辉, 吴敏健, 杨金珊, 等. 频闪喉镜和气流动力学检测在预判甲状腺术后单侧声带麻痹早期恢复声带运动的价值[J]. 临床耳鼻咽喉头颈外科杂志, 2022, 36(10): 776-780. https://lceh.whuhzzs.com/article/doi/10.13201/j.issn.2096-7993.2022.10.010
[19] Succo G, Cirillo S, Bertotto I, et al. Arytenoid fixation in laryngeal cancer: radiological pictures and clinical correlations with respect to conservative treatments[J]. Cancers, 2019, 11(3): 360. doi: 10.3390/cancers11030360
[20] Katilmio H, Oztürkcan S, Ozdemir I, et al. A clinico-pathological study of laryngeal and hypopharyngeal carcinoma: correlation of cord-arytenoid mobility with histopathologic involvement[J]. Otolaryngol Head Neck Surg, 2007, 136(2): 291-295. doi: 10.1016/j.otohns.2006.08.022
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