Objective: To explore the efficacy of ansa cervicalis anterior root-recurrent laryngeal nerve (RLN) anastomosis in the treatment of unilateral vocal fold paralysis (UVFP) and to analyze the effect of different pathogenic factors on efficacy. Methods: From January 2010 to January 2022, 428 patients (187 males and 241 females) at Changhai Hospital with UVFP who underwent ansa cervicalis anterior root-RLN anastomosis due to thyroid surgery, thoracic surgery, idiopathic vocal ford paralysis or high cranial base injury were analyzed. The course of nerve injury ranged from 6 to 24 months. Videostroboscopy, auditory perceptual evaluation parameters (GRBAS including Grade, Roughness, Breathiness, Asthenia, Strain), Voice Handicap Index (VHI-10), acoustic analysis including Jitter, Shimmer and noise to harmonic ratio (NHR), maximum phonation time (MPT) and laryngeal electromyography were used to evaluate the surgery efficacy, and the therapeutic difference of the above 4 different etiology patients receiving the operation was compared. Data processing was performed using SPSS 26.0 statistical software, and Wilcoxon signed rank test was used. Kruskal Wallis one-way ANOVA was used for those with equal variance. Results: At 12 months after operation, the affected vocal ford position, vocal ford edge, glottal closure, symmetry and regularity of vocal ford vibration were significantly improved in all four groups (P<0.01). G, R, B, A, S, VHI-10, Jitter, Shimmer and NHR were significantly lower than those before operation, while, MPT was significantly longer (P<0.01). Also, the maximum voluntary motor unit recruitment (VMUR) in the affected thyroarytenoid muscles and posterior cricoarytenoid muscles was significantly improved after surgery (P<0.01). However, the results of thyroid surgery group, thoracic surgery group and idiopathic vocal ford paralysis group were better than those of high cranial base injury group respectively, and the differences were statistically significant (P<0.05). Conclusion: Ansa cervicalis anterior root-RLN anastomosis has an obvious efficacy on the recovery of phonatory function in UVFP patients with different causes, but the high cranial base injury is significantly worse than that of vocal ford paralysis caused by other causes.
目的： 探讨颈襻前根喉返神经（recurrent laryngeal nerve，RLN）吻合术治疗单侧声带麻痹（unilateral vocal fold paralysis，UVFP）的疗效，分析不同致病因素对疗效的影响。 方法： 对2010年1月至2022年1月海军军医大学第一附属医院因甲状腺手术、胸腔手术、特发性声带麻痹或颅底高位损伤所致UVFP接受颈襻前根RLN吻合术的428例患者进行分析，其中男187例，女241例；神经损伤病程6~24个月。采用频闪喉镜、主观听感知评估参数（GRBAS）评分（参数包括总嘶哑度G、粗糙声R、气息声B、无力声A、紧张声S）、嗓音障碍指数（VHI-10）、嗓音客观检测指标（包括频率微扰Jitter、振幅微扰Shimmer、噪谐比NHR）、最长发声时间（MPT）以及喉肌电图检查等对手术疗效进行评价，同时比较上述4种不同病因患者接受该术式的疗效差异。以SPSS 26.0 统计软件进行数据处理，并使用 Wilcoxon 符号秩检验，方差齐者采用Kruskal-Wallis单因素方差分析。 结果： 4组患者在术后12个月时，频闪喉镜结果均显示患侧声带位置、边缘、声门闭合度、声带振动对称性和规律性较术前明显改善（P值均<0.01）；术后G、R、B、A、S、VHI-10、Jitter、Shimmer、NHR均明显小于术前，MPT则明显长于术前（P值均<0.01）；术后患侧甲杓肌和环杓后肌最大随意运动运动单位募集相相较术前均明显改善（P值均<0.01）。但甲状腺手术损伤组、胸腔手术损伤组、特发性声带麻痹组的上述结果均较颅底高位损伤组结果更佳，差异有统计学意义（P值均<0.05）。 结论： 颈襻前根RLN吻合术对不同原因引起的UVFP患者的嗓音功能恢复均有明显效果，但颅底高位损伤明显差于其他原因引起的声带麻痹。.