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- Autogenous Fat Intracordal Injection as Treatment for Unilateral Vocal Palsy
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題名 | Autogenous Fat Intracordal Injection as Treatment for Unilateral Vocal Palsy=以聲帶注射自體脂肪組織治療單側聲帶麻痺 |
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作者 | 張欣平; 張學逸; Chang, Hsin-pin; Chang, Shyue-yih; |
期刊 | 中華醫學雜誌 |
出版日期 | 19960800 |
卷期 | 58:2 1996.08[民85.08] |
頁次 | 頁114-120 |
分類號 | 416.896 |
語文 | eng |
關鍵詞 | 自體脂肪; 喉纖維鏡頻閃錄影; 聲帶內注射; 經口注射; 單側聲帶麻痺; Autogenous fat; Flexible laryngovideostroboscopy; Intracordal injection; Transoral injection; Unilateral vocal palsy; |
中文摘要 | 背景 聲帶注射因費時少、無須做頸部切口,仍是治療單側聲帶麻痺 引起的聲門閉合不全之重要方法。在各種聲帶注射用的新物質中,自體脂肪因 容易取得、無須花費以及不會引起異物或過敏反應,而引起我們注意。本文報 告我們以聲帶注射自體脂肪組織治療單側聲帶麻痺引起的聲門閉合不全的初步 經驗。 方法 在局部麻醉下,以針筒抽取法由大腿或下腹取得自體脂肪。在抽取及處 理自體脂肪時,我們採取了一些預防措施,以降低脂肪的吸收。然後在纖維鏡 頻閃錄影系統監控下,經口直入特製彎針注射器做聲帶注射。手術前及術後定 期做音聲評估,包括,喉纖維鏡頻閃錄影、患者對自己聲音的評估、語言治療 師對其音聲(主要是對其中氣息聲及嘶啞度)的評分、最長發聲時間以及平均氣 流速率。 結果 共有19例接受此項治療,其中17例可順利完成手術,臨床可用率為 89.5%。術中我們觀察到聲帶注射自體脂肪對降低後聲門閉合不全的效果並不明 顯。以喉纖維鏡頻閃錄影評估術後聲門閉合變化,顯示術後二週時16例中15 例變好,追蹤已達三個月的7例中5例仍比術前進步。術後二週時16例中12 例自覺聲音進步,追蹤已達三個月的7例中6例仍自覺比術前進步。不同個體 間脂肪吸收速率及量的變異相當大。受注射後聲帶無一呈不良型態或黏膜波動 變化。 結論 以前述方法做聲帶注射自體脂肪組織來治療單側聲帶麻痺引起的聲門閉 合不全的優點包括施行簡易、臨床可用率相當高、脂肪之取得不必額外花費、 對受注射聲帶無不良影響。大多數病患在術後,至少在短期內,都會有進步。 至於長期有效性仍有待追蹤。即使日後因脂肪吸收造成聲音再度變壞,亦能輕 易地以相同方法再注射。 |
英文摘要 | Background. Intracordal injection, which is less time-consuming and avoids neck incision, remains an important method to correct glottic insufficiency induced by unilateral vocal palsy. Among the various new materials proposed for intracordal injection, autogenous fat draws our attention for its availability without cost and high big-compatibility. This article reports our preliminary experiences of intracordal injection using autogenous fat to treat glottic insufficiency induced by unilateral vocal palsy. Methods. Autogenous fat is collected under local anesthesia by syringe aspiration from femoral or lower abdomen. Precautions to reduce resorption are taken while collecting and processing the fat. Under the guidance of flexible laryngovideostroboscopy, Bruning syringe with a bended needle is inserted transorally to make the intracordal injection. Serial pre-operation and postoperation evaluations by flexible laryngovideostroboscopy, the patient's self assessment on the voice, the speech pathologist's perceptual ratings on the breathiness and roughness of the patient's voice, maximum phonation time, and mean airflow rate are made. Results. A total of 19 cases were recruited for the treatment, and 17 of them completed the procedure. The clinical applicability was 89.5%. The fat injection had no obvious effect on the posterior glottic gap correction. The postoperative glottic gap estimated by the videostroboscopy, was improved in 15 of the 16 cases two weeks after operation, and in five of the seven cases who has been followed up for three months. Twelve of the 16 cases felt improved voice in two postoperative weeks, and six of the seven cases still felt the improvement three months after operation. The rate and amount of resorption varied greatly among individuals. None of the injected cords showed untoward morphological or vibratory changes up to three months after injection. Conclusions. Intracordal injection of autogenous fat to treat unilateral vocal palsy by the method we propose is relatively simple with high clinical applicability and no extra cost. None of the injected cords showed unfavorable changes. Most of the patients were improved after injection, at least for a short period of time. The long-term effectiveness remains to be observed. Repetition of the injection is also simple, if the voice results deteriorate due to resorption of the injected fat. |
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