二氧化碳激光与常规冷器械切除声带良性病变的疗效比较

Comparison of the surgical effect of carbon dioxide laser and conventional cold instruments for excision of benign vocal cord lesions

摘要:

目的 比较二氧化碳激光与常规冷器械切除声带良性病变的手术效果。方法 选取2017年12月—2020年12月于四川省会理市人民医院和四川省肿瘤医院接受治疗的200例良性声带病变患者，依据双盲法随机分为A组(100例)与B组(100例)。A组行常规冷器械法治疗，B组二氧化碳激光切除术治疗，术后对各组视频频闪、声学分析和语音障碍指数(VHI)进行评价。结果 两组结节、息肉、囊肿、黏膜白斑分布例数对比无明显差异(P>0.05)。两组术后3个月的闪烁噪声、嗓音抖动、基频均小于术前,术后3个月的最大发声时间大于术前。但两组术前和术后3个月的闪烁噪声、嗓音抖动、基频、最大发声时间对比差异无统计学意义(P>0.05)。两组患者术后3个月的VHI的躯体、功能、情感、总计得分均小于术前，但经比较差异无统计学意义(P>0.05)。结论 两种手术方法在处理良性声带病变方面都有良好的疗效，但各有其优缺点。

关键词:声带良性病变;二氧化碳激光;常规冷仪器;视频频闪;声学分析;语音障碍指数

Abstract:

Objective To compare the surgical effects of carbon dioxide laser and conventional cold instruments in the removal of benign vocal cord lesions.Methods A total of 200 patients with benign vocal cord lesions who were treated in People's Hospital of Huili City and Sichuan Cancer Hospital from December 2017 to December 2020 were selected and divided into group A (100 cases) and group B (100 cases) according to double-blind method. Group A was treated with conventional cold instrument therapy, and group B was treated with carbon dioxide laser ablation. Video stroboscopic, acoustic analysis and VHI(voice handicap index,VHI) were used to evaluate each group after operation.Results There was no significant difference in the distribution of nodules, polyps, cysts and leukoplakia between the two groups (P>0.05). The flicker noise, voice jitter, and fundamental frequency of the two groups at 3 months after surgery were all lower than those before surgery, and the maximum vocalization time at 3 months after surgery was longer than that before surgery. However, there was no significant difference in flicker noise, voice jitter, fundamental frequency, and maximum vocalization time between the two groups preoperative and postoperative 3 months (P>0.05). The physical, functional, emotional and total of the VHI of patients postoperative 3 months were all lower than those preoperative, but the difference was not statistically significant between the two groups (P>0.05).Conclusion Both surgical techniques have good results in treating benign vocal cord lesions, but each has its advantages and disadvantages.

Key words:Benign vocal cord lesions;CO₂ laser;Conventional cold instrument;Video stroboscopic;Acoustic analysis;Voice handicap index(VHI)