特发性单侧声带麻痹预后及喉肌电图特征分析

Prognosis and Laryngeal Electromyography Features of Idiopathic Unilateral Vocal Fold Paralysis

胡蓉;徐文;林毓鸿;程丽宇;

1:首都医科大学附属北京同仁医院耳鼻咽喉头颈外科

摘要
目的探讨特发性单侧声带麻痹患者的预后及喉肌电图特征。方法回顾性分析29例(14~75岁,中位年龄36岁)经喉肌电图证实为特发性单侧声带麻痹患者的临床资料,左侧麻痹22例,右侧麻痹7例,初诊病程为20天~10年。于初诊及初诊后3个月、6个月、1年、2年、3年进行嗓音的主观听感知评估(GRBAS)及频闪喉镜检查,初诊及初诊后6个月行喉肌电图检查,比较嗓音嘶哑程度、声带运动及喉返神经损伤程度变化。结果初诊时24例(82.8%)患者为中重度声嘶(G2~3级),频闪喉镜下见声带运动受限7例(24.1%),声带固定22例(75.9%),其中固定于旁正中位12例,固定于外展位10例。喉肌电图显示喉返神经功能完全损伤9例(31.0%),不全损伤20例(69.0%),其中内收支功能正常1例(3.4%),不全损伤16例(55.2%),完全损伤12例(41.4%);外展支功能正常6例(20.7%),不全损伤9例(31.0%),完全损伤14例(48.3%)。随访3年,21例(72.4%)患者声嘶改善(15例为患侧声带运动改善,6例为健侧代偿),其中嗓音恢复正常9例(31.0%)(7例患侧声带运动恢复正常,2例为健侧代偿);喉返神经不完全损伤患者的声嘶恢复率(35.0%)明显高于完全损伤患者(11.1%)。15例(51.7%)患者声带运动改善(运动恢复正常7例,24.1%)。20例(69.0%)患者喉肌电图改善,其中2例(10.0%)患者喉肌电图恢复正常,喉返神经内收支功能的改善率(69.0%)高于外展支(34.5%)。结论本组特发性单侧声带麻痹患者喉返神经不全损伤的比率较高,患者的声嘶改善率为72.4%,声带运动改善率为51.7%;半年复查时患者喉肌电图的改善率为69.0%,喉返神经内收支功能的改善情况明显好于外展支。
关键词
声带麻痹;特发性;喉返神经;喉肌电图;预后
基金项目(Foundation):
北京市自然科学基金(7172051);; 北京市医院管理局“青苗”计划专项经费(QML20170201);; 北京市东城区优秀人才培养基金联合资助
作者
胡蓉;徐文;林毓鸿;程丽宇;
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