改良自体脂肪声带注射治疗单侧声带麻痹的临床观察

Clinical observational of modified autologous fat injection in the treatment of unilateral vocal cord paralysis

摘要:

目的 系统评估自体脂肪声带注射术治疗病程超过6个月的单侧声带麻痹患者的疗效，并探讨影响治疗效果的关键因素。方法 采用前瞻性队列研究设计，纳入2018年1月—2022年12月接受自体脂肪声带注射术的单侧声带麻痹手术患者39例。通过改良的脂肪处理技术(两次梯度离心法)获取移植脂肪，对患者术前及术后1、3、6、12个月进行主/客观嗓音评估，GRBAS评分、嗓音障碍指数(VHI)、声学分析和频闪喉镜检查。结果 术后12个月复查，患者VHI总分从术前的(68.5±25.3)分降至(22.7±18.4)分，差异具有统计学意义(P＜0.001)。多因素回归分析显示年龄(β=-0.42，P=0.001)和注射剂量(β= 5.87，P=0.003)是影响治疗效果的独立预测因素。结论 规范化的脂肪处理流程结合精准注射技术可显著提高手术疗效，是治疗单侧声带麻痹的安全有效方法。

Abstract:

Objective To systematically evaluate the efficacy of autologous fat vocal cord injection in patients with unilateral vocal cord paralysis lasting more than 6 months and to identify key factors influencing treatment outcomes. Methods A prospective cohort study was conducted, enrolling 39 patients who underwent unilateral vocal cord paralysis surgery with autologous fat injection between January 2018 and December 2022. The injected fat was obtained through a modified fat processing technique (two-step gradient centrifugation method). Subjective and objective voice evaluations were performed for the patients before the operation and at 1, 3, 6, and 12 months after the operation, including GRBAS scale, voice handicap index (VHI), acoustic analysis, and stroboscopic laryngoscopy. Results At 12 months after surgery, the total VHI score significantly decreased from (68.5±25.3) before surgery to (22.7 ±18.4) (P<0.001). Multivariate regression analysis identified age (β=-0.42, P=0.001) and injection volume (β=5.87, P=0.003) as independent predictors of treatment outcomes. Conclusion Standardized fat processing procedure combined with precise injection technique can significantly improve surgical efficacy, making it a safe and effective method for treating unilateral vocal cord paralysis.