改良自体脂肪声带注射治疗单侧声带麻痹的临床观察研究
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1.温州医科大学温州市第三临床学院 温州市人民医院 耳鼻咽喉头颈外科;2.浙江大学附属邵逸夫医院 耳鼻咽喉头颈外科;3.温州医科大学附属第一医院 耳鼻咽喉头颈外科

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Clinical observational study of modified autologous fat injection in the treatment of unilateral vocal cord paralysis
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1.Department of Otolaryngology Head ang Neck Surgery,The Wenzhou Third Clinical Institute Affiliated To Wenzhou Medical University Wenzhou People'2.'3.s Hospital

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    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长期疗效,并探讨影响手术效果的关键因素。方法 采用前瞻性队列研究设计,纳入2018年1月至2022年12月期间39例接受手术的患者。通过改良的脂肪处理技术(两次梯度离心法)获取移植脂肪,评估术前及术后1、3、6、12个月的主客观嗓音参数变化,包括GRBAS评分、嗓音障碍指数(VHI)、频闪喉镜检查及声学分析。结果术后12个月,84.6%的患者(33/39)发音恢复正常(G0级),VHI总分从术前的68.5±25.3分显著降至22.7±18.4分(P<0.001)。多因素回归分析显示病程(β=-0.32,P=0.004)、离心次数(β=0.25,P=0.008)和注射精度(β=0.41,P=0.002)是影响手术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,是治疗慢性单侧声带麻痹的安全有效方法。

    Abstract:

    Objective To systematically evaluate the long-term efficacy of autologous fat injection in patients with unilateral vocal cord paralysis with a course of more than 6 months, and to explore the key factors affecting the surgical effect. Methods A prospective cohort study was used to enroll 39 patients who underwent surgery from January 2018 to December 2022. The transplanted fat was obtained by a modified fat treatment technique (two-step gradient centrifugation), and the subjective and objective voice parameters were evaluated before and at 1, 3, 6 and 12 months after surgery, including GRBAS score, voice dysphonia index (VHI), strobe laryngoscopy and acoustic analysis. Results At 12 months after surgery, 84.6% (33/39) of patients had normal pronunciation (G0 grade), and the total VHI score decreased significantly from 68.5±25.3 to 22.7±18.4 (P<0.001). Multivariate regression analysis showed that disease duration (β=-0.32, P=0.004), centrifugation times(β=0.25, P=0.008) and injection accuracy (β=0.41, P=0.002) were independent predictors of surgical outcome. Conclusions Standardized fat treatment process combined with precision injection technology can significantly improve the surgical efficacy, which is a safe and effective method for the treatment of chronic unilateral vocal cord paralysis.

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  • 收稿日期:2025-04-18
  • 最后修改日期:2025-05-20
  • 录用日期:2025-05-21
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