以微粉化AlloDerm注射喉整形術治療聲帶萎縮

Micronized AlloDerm Injection Laryngoplasty as a Treatment for Vocal Fold Atrophy

陳建志(Jiann-Jy Chen) ； 熊明旺(Ming-Wan Hsiung) ； 林曜祥(Yaoh-Shiang Lin) ； 王智弘(Chih-Hung Wang)

《台灣耳鼻喉頭頸外科雜誌》 43卷5期 (2008/10) Pp. 121-128

https://doi.org/10.6286/2008.43.5.121

摘要

注射喉整形術可以用來治療不同聲帶疾病所產生的聲門閉合不全，目前沒有一種注射用的材料是盡善盡美的，我們仍試圖找尋更好的材料。
材料及方法：回溯性地收集2003年11月至2004年1月間，因聲帶萎縮導致聲門閉合不全而接受微粉化AlloDerm注射喉整形術之病患，共有7名（男2，女5），年齡分布32~74歲，平均44歲。手術皆在全身麻醉下進行，對兩側聲帶甲杓肌內側中間1/3處進行注射，注射劑量爲0.4~1.0 mL，平均0.41 mL。術前術後均接受影像喉閃頻內視鏡檢查及音響分析。
結果：術後均無併發症發生，追蹤時間爲2~16.5個月，平均6.7個月。術後1週，有5名閉合完整，其中3名於術後1個月再度出現聲門間隙。術後1個月之音響分析結果顯示，排除1名數據不全者後，擾頻(jitter)減少者4名，擾幅(shimmer)減少者6名，最大發聲時間延長者6名，S/Z比率往1.0靠近者3名，而諧音對噪音比進步者6名。長期追蹤者有3名（6.5~16.5個月），僅1名閉合完整。
結論：微粉化AlloDerm注射喉整形術可用於治療聲帶萎縮所導致的聲門閉合不全，但是，對於後間隙的治療效果較差；而且，AlloDerm在轉化成穩定的組織後，體積會縮減。長期追蹤時，進行性的聲帶萎縮可能會影響到往後的效果。

關鍵字

注射喉整形術 ； 微粉化AlloDerm ； 聲帶萎縮 ； 聲門閉合不全

並列摘要

BACKGROUND: Glottic insufficiency can be corrected with injection laryngoplasty. Up to the present, a perfect injectable substance has not been identified. Thus, an improved injectable substance is needed.
METHODS: Between November 2003 and January 2004, seven patients (two males and five females), who suffered vocal fold atrophy, underwent micronized AlloDerm injection laryngoplasty and were enrolled in this study. Their ages ranged from 32 to 74 years with a mean age of 44 years. Under endotracheal general anesthesia, the major procedure was injections over the middle third portion of the bilateral vocal fold using volumes varying from 0.4 mL to 1.0 mL with the average being 0.41 mL. Patient data, including pre-operative and post-operative information, voice analysis and videolaryngostrobscopy, were retrospectively obtained.
RESULTS: The follow-up time ranged from 2 to 16.5 months with an average of 6.7 months. No post-operative complications occurred. One week after surgery, five of the patients showed complete glottic closure; however, one month after surgery, a glottic gap had recurred in three of them. One months after surgery, one patient did not undergo a complete voice analysis, four showed decreased jitter, six showed decreased shimmer, six had a longer maximal phonation time, three had a better S/Z ratio, and six had an improved harmonic-to-noise ratio. Finally, three patients underwent long-term follow-up (6.5~16.5 months), and only one of them was found to have complete glottic closure.
CONCLUSION: Micronized AlloDerm injection laryngoplasty can improve glottic closure in patients with vocal fold atrophy, but fails to correct a posterior chink. In addition, the volume of AlloDerm seems to reduce as it is transformed into stable tissue. During long-term follow-up, progressive vocal fold atrophy may influence the treatment's result.

並列關鍵字

injection laryngoplasty ； micronized AlloDerm ； vocal fold atrophy ； glottic insufficiency