Peretti Giorgio, Piazza Cesare, Balzanelli Cristiano, Mensi Maria C, Rossini Manuela, Antonelli Antonino R
Department of Otolaryngology, University of Brescia, Spedali Civili, Brescia, Italy.
Ann Otol Rhinol Laryngol. 2003 Sep;112(9 Pt 1):759-63. doi: 10.1177/000348940311200903.
Radiotherapy contends with endoscopic surgery for the role of treatment of choice for Tis-T1 glottic cancer. The amount of vocal cord to be surgically removed logically depends on the surface and deep extension of the neoplasm. Thus, a prerequisite for proper management includes an analysis of the voice changes after each of the progressive types of cordectomy described in the European Laryngological Society Classification. Between January 1998 and December 2000, 89 patients with glottic cancer (8 Tis, 63 T1a, 18 T1b) underwent different types of endoscopic cordectomy. Perceptual analysis (GRBAS scale); objective analyses of jitter, shimmer, and noise-to-harmonics ratio; and subjective (Voice Handicap Index) evaluation of voice were performed in 51 patients. Statistical evaluation of preoperative and postoperative objective results by analysis of covariance, as well as perceptual and subjective data, showed significant voice improvement after type I and II cordectomies, with the voice attaining nearly normal parameters. By contrast, after type III, IV, and V cordectomies, the vocal outcome was not significantly different from the preoperative pattern. It can therefore be concluded that type I and II resections, whenever indicated, are adequate procedures even for professional voice users. By contrast, accurate counseling is mandatory before type III, IV, and V cordectomies.
放射疗法与内镜手术在Tis-T1期声门癌的首选治疗方法这一角色上存在竞争。手术切除声带的量在逻辑上取决于肿瘤的表面和深部扩展情况。因此，恰当治疗的一个先决条件包括对欧洲喉科学会分类中描述的每种渐进性声带切除术类型后的声音变化进行分析。1998年1月至2000年12月期间，89例声门癌患者（8例Tis，63例T1a，18例T1b）接受了不同类型的内镜声带切除术。对51例患者进行了感知分析（GRBAS量表）、抖动、闪烁及噪声与谐波比的客观分析以及声音的主观（嗓音障碍指数）评估。通过协方差分析对术前和术后客观结果以及感知和主观数据进行统计评估，结果显示I型和II型声带切除术后声音有显著改善，声音参数接近正常。相比之下，III型、IV型和V型声带切除术后，嗓音结果与术前模式无显著差异。因此可以得出结论，I型和II型切除术，只要有指征，即使对于职业用嗓者也是合适的手术方法。相比之下，在进行III型、IV型和V型声带切除术之前，必须进行准确的咨询。
