内镜下应用新型组织工程材料修复喉返神经损伤引起的声带麻痹的效果

Effect of endoscopic repair of vocal fold paralysis caused by laryngeal nerve injury using a novel tissue engineering material

摘要:

目的 探讨内镜下应用新型组织工程材料修复喉返神经损伤引起的声带固定的效果。方法 选取上海市胸科医院患者10例。其中，男6例，女4例，平均（63.00±9.00）岁，均为胸外科术后出现声音嘶哑症状，喉镜或食管镜证实为声带麻痹。在喉镜/食管镜下使用脱细胞真皮基质注射喉成形术治疗声带麻痹，采用嗓音障碍指数（VHI）和嗓音相关生活质量（V-RQOL）量表评估患者术前、术后3、10、20和30 d的嗓音功能。结果 手术过程顺利，患者无过敏，术后无出血等并发症。90%（9/10）的患者VHI有改善，100%（10/10）的患者在治疗后V-RQOL有所改善。趋势回归分析发现，在接受手术治疗后，VHI和V-RQOL都有下降趋势。术后随访1年，所有患者嗓音恢复良好，其V-RQOL最低。结论 脱细胞真皮基质注射喉成形术，可以有效、安全地治疗因喉返神经损伤引起声带麻痹所致的喉功能不全，值得临床应用。

Abstract:

Objective This paper will discuss the clinical effects of using a novel tissue engineering material for endoscopic repair of laryngeal nerve damage-induced vocal fold paralysis.Methods 10 patients were selected, including 6 males and 4 females with a mean age of (63.00±9.00) years. All the patients presented with hoarseness symptoms after thoracic surgery, and laryngoscopy/esophagoscopy confirmed vocal fold paralysis. Under laryngoscopy/esophagoscopy, acellular dermal matrix injection laryngeal reconstruction was used to treat vocal fold paralysis, and the voice function of patients was evaluated before surgery and 3, 10, 20, and 30 days after surgery using two scales: voice handicap index (VHI) and voice-related quality of life (V-RQOL).Results The surgical procedure was smooth, and there were no allergic reactions or complications such as bleeding after surgery. 90% (9/10) of patients self-assessed improvement in VHI, and 100% (10/10) of patients reported improvement in V-RQOL after treatment. Trend regression analysis found that there was a downward trend in the VHI and V-RQOL after surgical treatment. At 1-year postoperative follow-up, all patients had better voice recovery, with the lowest V-RQOL related to voice.Conclusion Injection laryngoplasty using acellular dermal matrix can effectively and safely treat vocal fold paralysis caused by laryngeal nerve damage, resulting in voice disorders. It is worthy of clinical application.