微创医学

目的观察视频支撑喉镜下腹侧微瓣技术修复声带良性病变切除术后游离缘缺损的临床效果。方法选取59例声带良性病变切除术后游离缘缺损患者作为研究对象，根据手术方案将其分为对照组30例（视频支撑喉镜下切除声带病损后创面旷置）和观察组29例（视频支撑喉镜下切除病损的同时采用腹侧微瓣技术修复声带缺损）。比较两组患者自感术后声音恢复到最佳状态的时间、术后2个月内镜下的手术效果，以及术前和术后2个月的嗓音功能（主观听感知功能和主观感受）。结果所有患者均顺利完成手术，安全切除病变组织后，观察组的声带腹侧微瓣均成功覆盖声带缺损，术后2个月患者声带黏膜光滑，声带闭合情况良好。观察组患者自感术后声音恢复到最佳状态的时间短于对照组，手术总有效率高于对照组、疗效优于对照组（均P＜0.05）。术前，两组患者的嗓音GRBAS评分、嗓音障碍指数（VHI）评分差异均无统计学意义（均P＞0.05）；术后2个月，观察组患者的嗓音GRBAS评分、VHI评分均低于术前且低于对照组（均P＜0.05）。结论采用视频支撑喉镜下腹侧微瓣技术修复声带良性病变切除术后游离缘缺损，可保证黏膜上皮的完整性，有利于促进声带创伤愈合及嗓音功能的恢复。

ObjectiveTo observe the clinical effect of ventral micro-flap technique under video-assisted self-retaining laryngoscope in repairing free margin defects after resection of benign vocal cord lesions. MethodsA total of 59 patients with free margin defects after resection of benign vocal cord lesions were selected as the research objects. According to the surgical protocol, they were divided into a control group of 30 cases (wound exclusion after resection of vocal cord lesions under video-assisted self-retaining laryngoscope) and an observation group of 29 cases (repairing vocal cord defects using ventral micro-flap technique at the same time as resecting lesions under video-assisted self-retaining laryngoscope). The two groups were compared in terms of the time for self-perceived voice recovery to the best state after surgery, the surgical effect of endoscopic surgery at 2 months postoperatively, and the voice function (subjective auditory perceptual function and subjective feeling) preoperatively and 2 months postoperatively. ResultsSurgeries were performed successfully in all patients. In the observation group, the vocal cord defects were successfully covered by the ventral micro-flap of the vocal cords after the lesion tissues were safely excised, the vocal cord mucosa was smooth and the vocal cord closed fine 2 months after surgery. In the observation group, the time for self-perceived voice recovery to the best state after surgery was shorter than that in the control group, and the total effective rate and efficacy of the surgery were higher or better than those in the control group (all P＜0.05). Before surgery, there was no statistically significant difference in the voice GRBAS score or the voice handicap index (VHI) score between the two groups (all P＞0.05). Two months after surgery, the voice GRBAS score and the VHI score of the observation group were lower than those before surgery and those of the control group (all P< 0.05). ConclusionThe ventral micro-flap technique under video-assisted self-retaining laryngoscope used in repairing free margin defects after resection of benign vocal cord lesions can ensure the integrity of the epithelium mucosa and is conducive to promoting the healing of vocal cord wounds and the recovery of voice function.