Comparison of laser cauterization with general anesthesia microscopically supported laryngoscope and conventional microinstrumentally-supported laryngoscope resection in the treatment of vocal cord polyps

doi:10.3760/cma.j.issn.1007-1245.2024.02.019

Abstract

Abstract:

Objective　To study the application of laser cauterization with general anesthesia microscopically supported laryngoscope in the treatment of vocal cord polyps. Methods　The prospective study selected 90 patients with vocal cord polypectomy admitted to Bayannur Hospital from March 2019 to May 2022, and the patients were randomly divided into an observation group (47 cases) and a control group (43 cases) according to the envelope method. In the control group, 23 males and 20 females, aged (50.12±1.85) years, were treated with conventional microinstrumentally-supported laryngoscope resection. In the observation group, 25 males and 22 females, aged (49.75±2.18) years, were treated with laser cauterization with general anesthesia microscopically supported laryngoscope. The surgical results, Grade of Roughness, Breathiness, Asthenia, and Strain (GRBAS), Voice Handicap Index (VHI) score, Generic Quality of Life Inventory-74 (GQOL-74) score, and complications were compared between the two groups. t test and χ² test were used. Results　The overall response rate of the observation group was 93.62% (44/47), and there was no statistically significant difference compared with that of the control group [86.05% (37/43)] (χ²=1.430, P=0.232). After surgery, the total hoarseness [(1.39±0.41) in the observation group and (1.61±0.34) in the control group], rough sound [(1.36±0.50) in the observation group and (1.42±0.52) in the control group], breath sound [(0.91±0.52) in the observation group and (0.94±0.53) in the control group], and VHI score [(11.48±7.36) points in the observation group and (12.04±7.52) points in the control group] in both groups were lower than those before surgery, and the postoperative total hoarseness of the observation group was lower than that of the control group [(1.39±0.41) vs. (1.61±0.34)], with statistically significant differences (all P<0.05). The scores of physical health [(20.14±4.02) points], mental health [(22.57±4.86) points], material life [(13.54±3.57) points], and social function [(16.78±3.71) points] of the observation group were higher than those of the control group [(16.47±3.46) points, (19.67±3.76) points, (11.49±3.24) points, and (13.47±3.16) points], with statistically significant differences (t=4.621, 3.145, 2.843, and 4.535; all P<0.05). The incidence of complications of the observation group was 8.51% (4/47), which was lower than that of the control group [25.58% (11/43)], with a statistically significant difference (χ²=4.712, P=0.030). Conclusion　Compared with conventional microinstrumentally-supported laryngoscope resection, patients with vocal cord polyps treated by laser cauterization with general anesthesia microscopically supported laryngoscope have lower total hoarseness, higher postoperative quality of life, and fewer complications, which is worthy of use in clinical practice.

Key words:

Vocal cord polyps, Laser cauterization with general anesthesia microscopically supported laryngoscope, Conventional microinstrumentally-supported laryngoscope resection, Quality of life, Surgical effect, Complications, Voice Handicap Index

摘要：

目的　研究全麻显微镜支撑喉镜激光烧灼术在声带息肉治疗中的应用。方法　本文为前瞻性研究。选取2019年3月至2022年5月巴彦淖尔市医院治疗的90例行声带息肉切除术患者作为研究对象，根据信封法将患者随机分为观察组（47例）和对照组（43例）。对照组男23例、女20例，年龄（50.12±1.85）岁，采用支撑喉镜常规显微器械切除术；观察组男25例、女22例，年龄（49.75±2.18）岁，采用全麻显微镜支撑喉镜激光烧灼术。对比两组患者手术效果、嗓音嘶哑分级评估（GRBAS）、嗓音障碍指数量表（VHI）评分、生活质量综合评定问卷-74（GQOL-74）评分及并发症发生情况。采用t检验、χ²检验。结果　观察组治疗总有效率为93.62%（44/47），与对照组［86.05%（37/43）］比较，差异无统计学意义（χ²=1.430，P=0.232）。两组患者术后总嘶哑度［观察组（1.39±0.41）、对照组（1.61±0.34）］、粗糙声［观察组（1.36±0.50）、对照组（1.42±0.52）］、气息声［观察组（0.91±0.52）、对照组（0.94±0.53）］及VHI评分［观察组（11.48±7.36）分、对照组（12.04±7.52）分］均低于术前，且观察组术后总嘶哑度低于对照组［（1.39±0.41）比（1.61±0.34）］，差异均有统计学意义（均P<0.05）。观察组术后躯体健康［（20.14±4.02）分］、心理健康［（22.57±4.86）分］、物质生活［（13.54±3.57）分］及社会功能评分［（16.78±3.71）分］均高于对照组［（16.47±3.46）分、（19.67±3.76）分、（11.49±3.24）分、（13.47±3.16）分］，差异均有统计学意义（t=4.621、3.145、2.843、4.535，均P<0.05）。观察组并发症发生率为8.51%（4/47），低于对照组的25.58%（11/43），差异有统计学意义（χ²=4.712，P=0.030）。结论　应用全麻显微镜支撑喉镜激光烧灼术治疗声带息肉患者总嘶哑度更低，术后生活质量更高，并发症少，值得在临床推广应用。

关键词:

声带息肉, 全麻显微镜支撑喉镜激光烧灼术, 支撑喉镜常规显微器械切除术, 生活质量, 手术效果, 并发症, 嗓音障碍指数量表

Li Ting, Kong Min, Li Liming.

Comparison of laser cauterization with general anesthesia microscopically supported laryngoscope and conventional microinstrumentally-supported laryngoscope resection in the treatment of vocal cord polyps [J]. International Medicine and Health Guidance News, 2024, 30(2): 275-279.

李挺孔敏李利民.

全麻显微镜支撑喉镜激光烧灼术在声带息肉治疗中的应用 [J]. 国际医药卫生导报, 2024, 30(2): 275-279.

References

[1] 代伟林,杜晓辉,屈季宁,等.单侧声带囊肿与声带息肉患者手术前后嗓音声学的对比研究[J].听力学及言语疾病杂志,2023,31(1):65-67.DOI:10.3969/j.issn.1006-7299.2023. 01.014.
[2] Kim BH, Nam HJ. A case of vocal polyps improved with herbal medicine: a case report[J].Explore (NY),2021,17(3):220-222.DOI:10.1016/j.explore.2020.03.003.
[3] 朱峰炉,郑海明.支撑喉镜联合内镜切除术对声带息肉患者嗓音功能及生活质量的影响[J].中国现代医学杂志,2021,31(16):84-87.DOI:10.3969/j.issn.1005-8982.2021. 16.016.
[4] 郭颖,王美熠,王敬东.CO2激光联合复方安息香酊雾化吸入治疗声带息肉的临床观察[J].中国激光医学杂志,2020,29(4):203-207.DOI:10.13480/j.issn1003-9430.2020. 0203.
[5] Chen YL, Bao YY, Zhou SH, et al. Relationship between pepsin expression and dysplasia grade in patients with vocal cord leukoplakia[J].Otolaryngol Head Neck Surg,2021,164(1):160-165.DOI:10.1177/0194599820938654.
[6] 李红艳,徐文,胡蓉,等.嗓音障碍疾病GRBAS听主观评估特点分析[J].听力学及言语疾病杂志,2009,17(2):147-151.DOI:10.3969/j.issn.1006-7299.2009.02.016.
[7] 张武宁,唐安洲,徐志文,等.声带息肉患者手术前后VHI量表主观评估和 DSI 嗓音检测结果分析[J].听力学及言语疾病杂志,2013,21(5):494-496.DOI:10.3969/j.issn.1006- 7299.2013.05.015.
[8] Zhang XJ, Wang Y, Zhao W, et al. Vocal cord abnormal voice flow field study by modeling a bionic vocal system[J]. Advanced Robotics,2019,34(1):1-9.
[9] 孙宝印,张莉丽,王琰,等.声带息肉影响发声的虚拟仿真实验研究[J].现代电子技术,2021,44(6):149-154.DOI:10.16652/j.issn.1004-373x.2021.06.032.
[10] 彭静,李旭红,邹密,等. 嗓音训练改善早期声带息肉患者发声功能的效果[J]. 中国康复理论与实践,2020,26(8):936-940.DOI:10.3969/j.issn.1006-9771.2020.08.012.
[11] 徐彩霞,南宁,巩甜甜,等. 纤维喉镜与支撑喉镜对声带息肉患者临床疗效及负面情绪的影响[J]. 国际精神病学杂志,2021,48(5):872-875.DOI:10.13479/j.cnki.jip.2021.05.029.
[12] 汪世浩,刘根久. 支撑喉镜联合鼻内镜下内侧微瓣法切除声带息肉对嗓音声学指标的影响[J]. 检验医学与临床,2020,17(5):619-621,624.DOI:10.3969/j.issn.1672-9455.2020. 05.013.
[13] 刘杰,肖翠,邓利,等. 48例双侧广基型声带息肉患者不同术式疗效的主客观评估[J]. 临床耳鼻咽喉头颈外科杂志,2021,35(2):160-163.DOI:10.13201/j.issn.2096-7993. 2021.02.015.
[14] 张建军,汪家东,陈晨.支撑喉镜辅助等离子手术对声带息肉患者嗓音质量、疼痛介质及预后的影响[J].解放军医药杂志,2021,33(6):83-87.DOI:10.3969/j.issn.2095- 140X.2021.06.018.
[15] 彭静,谭洁,谢文亮,等.教师声带息肉患者的嗓音声学分析与嗓音障碍指数相关性研究[J].听力学及言语疾病杂志,2021,29(2):173-176.DOI:10.3969/j.issn.1006-7299. 2021.02.013.
[16] 王华,张洁,侯瑾,等.高频超声诊断声带息肉的初步研究[J].中华超声影像学杂志,2022,31(9):791-796.DOI:10.3760/cma.j.cn131148-20220208-00089.
[17] 杨丽云,周晓静,周恩晖,等.新型声带息肉挤切钳切除声带息肉的临床效果[J].宁夏医科大学学报,2022,44(3):317-320.DOI:10.16050/j.cnki.issn1674-6309.2022. 03.019.
[18] 王国良,冰丹,陈歆维,等.一种自研的弯曲硬管可视喉镜在困难气道声带息肉切除术中的应用[J].临床耳鼻咽喉头颈外科杂志,2022,36(6):463-466.DOI:10.13201/j.issn.2096- 7993.2022.06.011.
[19] 孙立保.视频支撑喉镜下手术治疗声带小结及声带息肉的临床效果[J].中国临床药理学与治疗学,2023,28(1):125.
[20] 刘盛林,徐英,陈晓宇,等.支撑喉镜联合硬质支气管内镜手术治疗喉部良性病变应用体会[J].中国中西医结合耳鼻咽喉科杂志,2022,30(6):450-452,468.DOI:10.16542/j.cnki.issn.1007-4856.2022.06.012.
[21] 罗腊红,刘志军,周小林,等. 显微支撑喉镜病损切除术联合ABCLOVE方案治疗声带息肉患者临床研究[J]. 临床军医杂志,2020,48(1):66-68,71.DOI:10.16680/j.1671-3826.2020.01.19.
[22] 费青,胡益民,曹雅男,等. 经鼻高流量氧疗在支撑喉镜下声带息肉摘除术中的应用[J]. 临床麻醉学杂志,2022,38(3):325-327. DOI:10.12089/jca.2022.03.022.
[23] 钱蔚颖,申会利. 支撑喉镜下显微切除术对广基型声带息肉患者嗓音恢复的影响[J]. 山西医药杂志,2020,49(5):552-554. DOI:10.3969/j.issn.0253-9926.2020.05.021.
[24] 张蕾,宋鹏龙,赵治纲,等. 会厌牵拉技术在支撑喉镜下声门暴露困难患者中的应用[J]. 中国耳鼻咽喉头颈外科,2022,29(2):130-131. DOI:10.16066/j.1672-7002.2022.02.016.
[25] 李伟,江晶,徐源. 可调式支撑喉镜辅以鼻内镜在声门暴露困难患者喉显微手术中的应用[J]. 听力学及言语疾病杂志,2020,28(4):410-412.DOI:10.3969/j.issn.1006-7299.2020.04.013.
[26] 臧艳姿,张贝贝,王广科,等. 声带息肉合并喉梗阻症状的治疗方法探讨[J]. 中国耳鼻咽喉头颈外科,2020,27(10):598-599. DOI:10.16066/j.1672-7002.2020.10.014.
[27] 冯绍斌,伦小川,谭健华,等. 六大解剖因素对支撑喉镜喉部手术相关并发症的临床预测评估[J]. 海南医学,2021,32(9):1158-1161. DOI:10.3969/j.issn.1003-6350.2021.09.019.
[28] 魏征,辛燕,吴黎黎,等. 1%丁卡因表面麻醉对全身麻醉支撑喉镜手术患者血流动力学的影响[J]. 中华医学杂志,2022,102(21):1590-1595. DOI:10.3760/cma.j.cn112137-20220131-00227.
[29] 蒋建华,解道宇,田如如,等. 支撑喉镜下激光补充切除非完整剥离的残余声带囊肿21例[J]. 中国内镜杂志,2021,27(8):71-75. DOI:10.12235/E20210002.
[30] 李欣,傅敏仪,徐建慧,等. 显微支撑喉镜低温等离子射频消融治疗早期声门型喉癌临床观察[J]. 中华显微外科杂志,2020,43(2):190-192. DOI:10.3760/cma.j.cn441206-20191111-00353.