【作者】 李艺；

【导师】 苏纪平；

【作者基本信息】 广西医科大学 ， 耳鼻咽喉头颈外科， 2010， 硕士

【摘要】 目的:本课题拟通过对于SCPL术前及术后颈部的MRI改变,观察SCPL术后MRI喉及颈部解剖的变异,并测量相关参数反映其变化,并分析相关解剖参数与其喉功能恢复的关系,为改良手术操作方法,改善喉功能提供理论数据。方法:回顾性分析2006年1月至2009年12月38例于广西医科大学第一附属医院耳鼻咽喉头颈外科进行SCPL术患者的临床资料及术前术后MRI资料,其中以术后行MRI随访,且临床资料完整的15例作为研究对象,所有病例均为男性,年龄50-70岁,平均56.25岁。观察SCPL术后喉功能恢复情况测量比较术前及术后MRI有关参数并分析参数变化与喉功能恢复的关系。结果:①α角、β角、L、E、A、AH、SPH、TPH参数术前后的改变有统计学意义,其测量值能反映杓区厚度、舌骨、会厌、喉体、杓区、环状软骨术前后变化;声门形态改变,声门长轴方向通常呈斜行或不对称,声带缩短、增厚表面光滑,形态呈弧形、三角形、梭形、“T”形和不规则形等。②研究结果表明一些参数如α角、舌骨大脚间距在CHEP术后出现改变,这些变化与其吞咽功能恢复快慢有关系,而且α角其术后大小可由术前大小决定。③气管套管拔管率为100%,CHEP与CHP术式组拔管时间有显著性差异,CHP拔管时间延长。胃管拔管率为100%,CHEP与CHP术式组拔管时间有显著性差异,CHP拔管时间延长。结论:①术后有统计学意义的参数:α角、β角、L、E、A、AH、SPH、TPH能反映SCPL术后喉部的改变。②与吞咽功能有关的参数:α角、舌骨大脚间距。术后α角>30°吞咽功能恢复快;α角<30°吞咽功能恢复慢,α角<10°的患者易导致术后α角<30°。舌骨大脚间距术后比术前减小的吞咽功能恢复快。③本研究SCPL患者术后喉功能恢复情况较好,与国内外报道相类似。更多还原

【Abstract】 Objective: The aim of this study for the imaging of MRI changes in the neck before and after SCPL, observed anatomical variation of throat and neck after SCPL, and analysis of relevant anatomical parameters and laryngeal function between surgical procedure for the modified method to improve laryngeal function to provide theoretical data.Methods: A retrospective analysis from January 2006 to December 2009 at the First Affiliated Hospital of Guangxi Medical University, Otolaryngology Head and Neck Surgery for SCPL for 38 patients with clinical and MRI data before and after operation, in which postoperative MRI follow-up , and 15 cases of complete clinical data for the study, all patients were male, aged 50-70 years, mean 56.25 years. Observe the recovery of laryngeal function after SCPL and compared MRI parameters of measurements and analysis of parameters with laryngeal function recovery. By SPSS16.0 statistical software for statistical analysis of the above.Results:①α-angle,β-angle, L, E, A, AH, SPH, TPH measurement parameters to reflect the hyoid bone, epiglottis, larynx, arytenoid area, cricoid cartilage, before and after surgery location, thickness spoon area, glottal morphological changes, the long axis of the glottis was usually oblique or asymmetrical vocal cord shortening, thickening and smooth surface curved shape, triangle, spindle, "T"-shaped and irregular.②The results show that the number of parameters such asα-angle, the distance between the two greater cornua of the hyoid bone postoperative change in CHEP, these changes have their swallowing function recovery relations, and theα-angle as the size of its operation by the decision of the preoperative size.③The tracheal tube extubation was 100%, CHEP and CHP surgical extubation time was significantly different, CHP prolonged extubation. Tube decannulation rate was 100%, CHEP and CHP surgical extubation time was significantly different, CHP extubation longer.Conclusion:①The significant parameters:α-angle,β-angle, L, E, A, AH, SPH, TPH can reflect the change of larynx after Postoperative.②swallowing-related parameters:αangle, distance between the two greater cornua of the hyoid bone. Quick recovery of swallowing function afterα-angle> 30°;αangle <10°after surgery and patients with easily lead angle toα<30°. Quick recovery of swallowing function which the distance between the two greater cornua of the hyoid bone reduces than Preoperative.③SCPL patients in this study the recovery of laryngeal function as better as reports of home and abroad.更多还原