支撑喉镜下CO2激光手术治疗声带息肉的疗效及对嗓音质量、生活质量及复发率的影响

Effect of CO2 laser surgery under self-retaining laryngoscope on polyp of vocal cord and its effect on voice quality, quality of life and recurrence rate

摘要:

目的 探讨支撑喉镜下CO₂激光手术在声带息肉（PVC）患者治疗中的应用价值。方法 选取2022年6月－2024年6月该院PVC患者168例，根据电脑随机法分为激光组（支撑喉镜下CO₂激光手术，84例）和钳夹组（支撑喉镜下喉钳夹牵拉术，84例）。比较两组患者临床疗效、围手术期情况、疼痛相关因子［神经肽Y（NPY）、P物质（SP）和β-内啡肽（β-EP）］、嗓音声学指标［谐波噪声比（HNR）、基频微扰值（Jitter）和标准化噪声能量（NNE）］、嗓音障碍指数-10（VHI-10）评分、并发症及复发率。结果 激光组总有效率为95.24%，高于钳夹组的80.95%，差异有统计学意义（P < 0.05）；激光组手术时间、首次发声时间和声音恢复时间短于钳夹组，术中出血量少于钳夹组，差异均有统计学意义（P < 0.05）；术后1和3 d，激光组血清NPY、SP和β-EP低于钳夹组，差异均有统计学意义（P < 0.05）；术后2和4周，激光组Jitter、NNE和VHI-10评分低于钳夹组，HNR高于钳夹组，差异均有统计学意义（P < 0.05）；两组患者并发症总发生率比较，差异无统计学意义（P > 0.05）；激光组复发率为7.50%，低于钳夹组的18.42%，差异有统计学意义（P < 0.05）。结论 支撑喉镜下CO₂激光手术治疗PVC效果显著，能优化手术流程，减轻患者疼痛应激反应，恢复嗓音功能，确保安全性，且能降低复发风险。

Abstract:

Objective To investigate the application value of CO₂ laser surgery under self-retaining laryngoscope in the treatment of polyp of vocal cord (PVC).Methods A total of 168 patients with PVC in our hospital from June 2022 to June 2024 were prospectively selected as the research subjects. According to the computer random method, they were divided into the laser group (CO₂ laser surgery under self-retaining laryngoscope, 84 cases) and the clamp group (laryngeal clamp traction under self-retaining laryngoscope, 84 cases). The clinical efficacy, perioperative conditions, pain-related factors [neuropeptide Y (NPY), substance P (SP), β-endorphin (β-EP)], voice acoustic indexes [harmony to noise ratio (HNR), fundamental frequency perturbation (jitter), normalised noise energy (NNE)], voice handicap index-10 (VHI-10) score, complications and recurrence rate were compared between the two groups.Results The total effective rate of the laser group was 95.24% higher than that of the clamp group 80.95%, and the difference was statistically significant (P < 0.05). The operation time, first vocalization time and sound recovery time of the laser group were shorter than those of the clamp group, while the intraoperative blood loss was less, and the differences were statistically significant (P < 0.05). The serum NPY, SP and β-EP in the laser group were lower than those in the clamp group at 1 d and 3 d after operation, and the differences were statistically significant (P < 0.05). At 2 and 4 weeks after operation, the Jitter, NNE and VHI-10 scores of the laser group were lower than those of the clamp group, and the HNR was higher, and the differences were statistically significant (P < 0.05). There was no significant difference in the total incidence of complications between the two groups (P > 0.05). The recurrence rate of the laser group was 7.50% lower than that of the clamp group (18.42%), and the difference was statistically significant (P < 0.05).Conclusion The effect of CO₂ laser surgery under self-retaining laryngoscope in the treatment of PVC patients is significant. It can optimize the operation process, reduce pain and stress, restore voice function, ensure safety, and reduce the risk of recurrence.