Piazza Cesare, Bolzoni Villaret Andrea, Redaelli De Zinis Luca Oscar, Cattaneo Augusto, Cocco Daniela, Peretti Giorgio
Department of Otorhinolaryngology, University of Brescia, Spedali Civili, Piazza Spedali Civili 1, 25123, Brescia, Italy.
Eur Arch Otorhinolaryngol. 2007 Oct;264(10):1185-90. doi: 10.1007/s00405-007-0330-0. Epub 2007 May 30.
Major glottic incompetence is often encountered after total (Type IV) and extended (Type V) cordectomies and is responsible for poor vocal outcome. Even though the vast majority of patients do not complain of significant limitations in daily life, a selected number of them eventually require some sort of phonosurgical treatment in order to improve voice quality. Different techniques have been described in the literature to ameliorate long-term vocal outcome. The aim of the present report was to retrospectively describe our experience in this challenging clinical scenario. Between April 1999 and March 2005, 24 patients previously treated by Type IV-V endoscopic cordectomies for T1 and T2 glottic cancer presented unsatisfactory vocal outcome in spite of intensive speech therapy and therefore underwent some form of phonosurgical treatment at our Department after at least 12 months without evidence of local-regional recurrence. Patients were treated by medialization thyroplasty with a Montgomery System Implant (two cases), Gore-Tex strips (16 cases), medialization thyroplasty with Gore-Tex associated with anterior commissure laryngoplasty (three cases), and augmentation with Vox Implant injection (three cases). Nineteen patients had comprehensive evaluation by videolaryngoscopic examination and subjective, perceptual, and objective voice analysis both in the pre-phonosurgical treatment period and after at least 12 months. Comparison of pre- and postoperative videolaryngoscopic findings revealed improved glottic closure in 74% of patients. Comparison between the pre- and postoperative subjective, perceptual, and objective voice analysis by the Wilcoxon matched-pair test showed a statistically significant improvement from a Voice Handicap Index mean value of 46 (preoperative) to 21 (postoperative); an improvement for each parameter of the GRBAS scale with statistically significant differences for G, B, A, and S, while R showed only an improving trend; and statistically significant improvement in the mean values of Jitter, Shimmer, Noise to Harmonic Ratio, and Maximum Phonation Time. In conclusion, the different delayed phonosurgical procedures herein used demonstrate the possibility to improve vocal outcomes after total and extended cordectomies in selected and highly motivated patients that have not achieved satisfactory performance after prolonged and intensive speech therapy.
在全喉（IV型）和扩大喉（V型）声带切除术后，常出现严重的声门闭合不全，这是导致嗓音预后不佳的原因。尽管绝大多数患者在日常生活中并未抱怨有明显限制，但仍有部分患者最终需要某种嗓音外科治疗以改善嗓音质量。文献中描述了不同的技术来改善长期嗓音预后。本报告的目的是回顾性描述我们在这一具有挑战性的临床情况下的经验。1999年4月至2005年3月期间，24例曾接受IV - V型内镜声带切除术治疗T1和T2声门癌的患者，尽管接受了强化言语治疗，但嗓音预后仍不理想，因此在至少12个月且无局部区域复发证据后，在我院接受了某种形式的嗓音外科治疗。患者接受了以下治疗：使用蒙哥马利系统植入物进行甲状软骨成形术（2例）、使用戈尔特斯条带（16例）、使用戈尔特斯联合前联合喉成形术进行甲状软骨成形术（3例）以及注射Vox植入物进行扩容（3例）。19例患者在嗓音外科治疗前及至少12个月后接受了视频喉镜检查以及主观、感知和客观嗓音分析的综合评估。术前和术后视频喉镜检查结果比较显示，74%的患者声门闭合改善。通过Wilcoxon配对检验对术前和术后主观、感知和客观嗓音分析进行比较，结果显示嗓音障碍指数平均值从术前的46显著改善至术后的21；GRBAS量表各参数均有改善，其中G、B、A和S有统计学显著差异，而R仅呈改善趋势；Jitter、Shimmer、噪声谐波比和最大发声时间的平均值有统计学显著改善。总之，本文所采用的不同延迟嗓音外科手术表明，对于经过长期强化言语治疗后仍未取得满意效果的特定且积极性高的患者，有可能改善全喉和扩大声带切除术后的嗓音预后。
