山东大学耳鼻喉眼学报 ›› 2020, Vol. 34 ›› Issue (1): 67-70.doi: 10.6040/j.issn.1673-3770.0.2019.349

• 论著 • 上一篇    

客观嗓音分析比较CO2激光术与传统剥脱术治疗声带白斑患者的疗效

沈敏1,屈季宁1,姜义道2   

  1. 1.武汉大学人民医院 耳鼻咽喉头颈外科, 湖北 武汉 430060;
    2.华中科技大学同济医学院附属荆州医院 耳鼻咽喉科, 湖北 荆州 434020
  • 发布日期:2020-03-06
  • 通讯作者: 屈季宁. E-mail:2749668346@qq.com

Evaluation the efficacy of a CO2 laser and traditional exfoliation in the treatment of vocal cord leukoplakia by using objective voice analysis

SHEN Min1, QU Jining1, JIANG Yidao2   

  1. 1. Department of Otolaryngology Head and Neck Surgery, People's Hospital of Wuhan University, Wuhan 430060, Hubei, China;
    2. Department of Otorhinolaryngology, Jingzhou Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jingzhou 434020, Hubei, China
  • Published:2020-03-06

摘要: 目的 运用客观嗓音分析比较CO2激光术与传统剥脱术治疗声带白斑的疗效。 方法 回顾性分析2018年10月至2019年5月住院治疗的确诊为声带白斑患者病历资料,筛选出行CO2和传统剥脱术患者,CO2治疗组、传统剥脱术治疗组,对比两组患者手术时间、术中出血量、术后有效率,分别于术后2周、1个月、2个月分析统计两组患者嗓音障碍指数(VHI),采用xion divas的嗓音分析软件,检测手术前及手术后2周、1个月、2个月基频微扰(Jitter)、振幅微扰(Shimmer)、最低音强(SPLmin)、最高基频(F0max)、基频(F0)、最长声音持续时间(MPT)、嗓音障碍指数(DSI)。 结果 CO2治疗组患者手术时间更短,术中出血量更少;CO2治疗组有效率高于传统剥脱术治疗组,疗效更佳;两组患者术后1个月、2个月VHI指数均较术前降低,且CO2治疗组VHI指数低于传统剥脱术治疗组;两组患者治疗后基频微扰、振幅微扰、最低音强均低于治疗前,基频、最长声音持续时间、嗓音障碍指数高于治疗前。 结论 采用CO2激光术治疗声带白斑较传统的剥脱术疗效更佳,能显著改善患者嗓音。

关键词: CO2激光术, 传统剥脱术, 声带白斑, 客观嗓音分析

Abstract: Objective To evaluate the efficacy of a CO2 laser and traditional exfoliation in the treatment of vocal cord leukoplakia by using objective voice analysis and to explore the value of objective voice analysis and the effects of the two treatment methods. Methods Medical records of patients with leukoplakia diagnosed in our department from January to February 2018 in 2017 were screened for CO2 and traditional exfoliation and retrospectively analyzed. The CO2 treatment group and the traditional exfoliation treatment group were denoted to be the observation and control groups, respectively; the postoperative effective rate was compared between these two groups. The Voice Disorder Index(VHI)was analyzed at 2 weeks, 1 month, and 3 months after surgery. XION DiVAS audio analysis software was used to detect preoperative and surgery 2 Weekly, January, March fundamental frequency perturbation(Jitter), amplitude perturbation(Shimmer), lowest sound intensity(SPLmin),(highest fundamental frequency)F0max, fundamental frequency(F0), longest sound duration(MPT), Voice Disorder Index(DSI). Results Compared to the control group, the observation group had a higher effective rate and a better curative effect. The VHI index in the two groups was lower than that of the preoperative group in the first and third months after operation, and the observation group The VHI index was lower than that of the control group, and the difference was statistically significant. In both groups, postoperative fundamental frequency perturbation, amplitude perturbation, and lowest sound intensity were lower than those before treatment, while fundamental frequency, longest sound duration, and snoring index was higher than those before treatment; a significant difference was noted between the observation group and the control group. The highest fundamental frequency after treatment was not significantly different from that before treatment. Conclusion For objective voice analysis, use of a CO2 laser for treatment of vocal cord leukoplakia is more effective than the use of traditional exfoliation and can significantly improve the patient's voice.

Key words: CO2 laser, Traditional stripping, Vocal cord leukoplakia, Objective voice analysis

中图分类号: 

  • R767.4
[1] 郑智英, 王斌全. 电子喉镜下声带息肉手术前后的嗓音声学评估[J]. 医学研究杂志, 2012, 41(9): 171-173. doi:10.3969/j.issn.1673-548X. 2012.09.055. ZHENG Zhiying, WANG Binquan. Voice acoustic evaluation of vocal cords after electronic laryngoscopy polyps operation[J]. Journal of Medical Reaserch, 2012, 41(9): 171-173. doi:10.3969/j.issn.1673-548X. 2012.09.055.
[2] 吕丹,陈媛,杨慧,等. 声带白斑的研究现状及挑战[J]. 中华耳鼻咽喉头颈外科杂志, 2018,53(8): 631-635. doi:10.3760/cma.j.issn.1673-0860. 2018.08.016. LV Dan, CHEN Yuan, YANG Hui, et al. Research status and challenges of vocal cord leukoplakia[J].Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2018,53(8): 631-635. doi:10.3760/cma.j.issn.1673-0860. 2018.08.016.
[3] Weller MD, Nankivell PC, McConkey C, et al. The risk and interval to malignancy of patients with laryngeal dysplasia; a systematic review of case series and meta-analysis[J]. Clin Otolaryngol, 2010, 35(5): 364-372. doi:10.1111/j.1749-4486. 2010.02181.x.
[4] 闫静, 杜小滢, 李娜, 等. 窄带成像内镜用于声带白斑诊断的意义[J]. 听力学及言语疾病杂志, 2018, 26(6): 628-631. doi:10.3969/j.issn.1006-7299. 2018.06.015. YAN Jing, DU Xiaoying, LI Na, et al. The application of narrow band imaging laryngoscopy in the diagnosis of vocal cord leukoplakia[J]. Journal of Audiology and Speech Pathology, 2018, 26(6): 628-631. doi:10.3969/j.issn.1006-7299. 2018.06.015.
[5] Nam JK, Kim HW, Lee DH, et al. Risk factors for transient urinary incontinence after holmium laser enucleation of the prostate[J]. World J Mens Health, 2015, 33(2): 88. doi:10.5534/wjmh. 2015.33.2.88.
[6] 赵春红, 李玉杰, 于敏. 低温等离子消融治疗声带白斑的临床疗效观察[J]. 中国眼耳鼻喉科杂志, 2018, 18(4): 262-263, 271. doi:10.14166/j.issn.1671-2420. 2018.04.012. ZHAO Chunhong, LI Yujie, YU Min. Clinical effect of low temperature plasma ablation treatment for vocal leukoplakia[J]. Chinese Journal of Ophthalmology and Otorhinolaryngology, 2018, 18(4): 262-263, 271. doi:10.14166/j.issn.1671-2420. 2018.04.012.
[7] Koss SL, Baxter P, Panossian H, et al. Serialin office laser treatment of vocal fold leukoplakia: disease control and voice outcomes[J].Laryngoscope, 2017, 127(7):1644-1651.
[8] 毛承刚, 万俐佳, 周小淳. 支撑喉镜下声带白斑的手术治疗及预后分析[J]. 中国耳鼻咽喉颅底外科杂志, 2017, 23(5): 461-465. doi:10.11798/j.issn.1007-1520. 201705015. MAO Chenggang, WAN Lijia, ZHOU Xiaochun. Surgical treatment under laryngoscope and prognosis of vocal cords leukoplakia[J]. Chinese Journal of Otorhinolaryngology-Skull Base Surgery, 2017, 23(5): 461-465. doi:10.11798/j.issn.1007-1520. 201705015.
[9] Diaz-de-Cerio P,Preciado J,Santaolalla F et al. Cost-minimisation and cost-effectiveness analysis comparing transoral CO2 laser cordectomy, laryngofissure cordectomy and radiotherapy for the treatment of T1-2, N0, M0 glottic carcinoma[J].Eur Arch Otorhinolaryngol, 2013, 270(4):1181-1188.
[10] 姜伟. 支撑喉镜下CO2激光切除声带息肉与声带白斑的疗效研究[J]. 中国疗养医学, 2018, 27(4): 396-397. doi:10.13517/j.cnki.ccm. 2018.04.025.
[11] Halawa WE, Rodríguez Fernández Freire A, Muñoz IV, et al. Assessment of effectiveness of acoustic analysis of voice for monitoring the evolution of vocal nodules after vocal treatment[J]. Eur Arch Otorhinolaryngol, 2014, 271(4): 749-756. doi:10.1007/s00405-013-2685-8.
[12] Lu D, Chen F, Yang H, et al. Changes after voice therapy in acoustic voice analysis of Chinese patients with voice disorders[J]. J Voice, 2018, 32(3): 386.e1-386386.e9. doi:10.1016/j.jvoice. 2017.05.005.
[13] 徐文, 李红艳, 胡蓉, 等. 嗓音障碍指数量表中文版信度和效度评价[J]. 中华耳鼻咽喉头颈外科杂志, 2008, 43(9): 670-675. doi:10.3321/j.issn:1673-0860. 2008.09.008. XU Wen, LI Hongyan, HU Rong, et al. Analysis of reliability And validity of the Chinese version of voice handicap index(VHI)[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2008, 43(9): 670-675. doi:10.3321/j.issn:1673-0860. 2008.09.008.
[14] 孟国珍, 陈向平, 侯东明, 等. 声带白斑的CO2激光治疗[J]. 应用激光, 2008, 28(3): 254-255. doi:10.3969/j.issn.1000-372X. 2008.03.019. MENG Guozhen, CHEN Xiangping, HOU Dongming, et al. CO2 laser treatment in leukoplakia of the vocal cords[J]. Applied Laser, 2008, 28(3): 254-255. doi:10.3969/j.issn.1000-372X. 2008.03.019.
[20] 董金辉. 计算机嗓音声学检测对声带良性增生性病变诊断作用研究:2017国际数字医学会数字中医药分会论文集[C]. 长沙:湖南中医药大学期刊杂志社, 2017.
[21] 黄前进, 李兆生, 许振跃. 嗓音训练治疗声门闭合不全所致功能性嗓音障碍的疗效分析[J]. 中国耳鼻咽喉颅底外科杂志, 2017, 23(5): 422-426. doi:10.11798/j.issn.1007-1520. 201705006. HUANG Qianjin, LI Zhaosheng, XU Zhengyue. Effect of voice training for functional voice disorder in patients with glottal dysraphism[J]. Chinese Journal of Otorhinolaryngology-Skull Base Surgery, 2017, 23(5): 422-426. doi:10.11798/j.issn.1007-1520. 201705006.
[22] 张玉波. 嗓音声学检测的主客观多维参数模型建立及相关性研究:2017国际数字医学会数字中医药分会论文集[C].长沙:湖南中医药大学期刊杂志社, 2017.
[23] 韩仲明. 嗓音声学检测分析[J]. 中国耳鼻咽喉头颈外科, 2006, 13(5): 351-353. doi:10.3969/j.issn.1672-7002. 2006.05.030.
[24] 吕倩, 彭鑫, 王晓雨, 等. 嗓音声学检测对喉白斑患者嗓音评估的临床价值[J]. 天津医药, 2014, 42(12): 1226-1228, 1229. doi:10.3969/j.issn.0253-9896. 2014.12.021. LV Qian, PENG Xin, WANG Xiaoyu, et al. Clinic value of the vocal acoustics on voice evaluation in patients with larynx leukoplakia[J]. Tianjin Medical Journal, 2014, 42(12): 1226-1228, 1229. doi:10.3969/j.issn.0253-9896. 2014.12.021.
[1] 王亚琳综述,陈剑秋审校. 声带白斑与癌前病变关系探讨及其研究进展[J]. 山东大学耳鼻喉眼学报, 2016, 30(6): 90-93.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!