Makeieff Marc, de la Breteque Amy, Guerrier B, Giovanni A
Service ORL Chirurgie Cervico-Faciale Hôpital Gui de Chauliac, Université de Médecine, Montpellier, France.
Laryngoscope. 2009 Apr;119(4):746-50. doi: 10.1002/lary.20125.
To gather information on the vocal and professional impact of supracricoid partial laryngectomy (SCPL).
Collection of quality of life data more than 12 months postsurgery, including expert-rated patient voice assessment (GRBAS [grade, roughness, breathiness, asthenia, strain] scale), self voice assessment, Voice Handicap Index (VHI), and socioprofessional data.
Sixty-four patients were evaluated after SCPL. The surgical procedure had been conducted for initial stage T1b or T2 glottic carcinoma. All patients had no recurrence, were decanulated, and did not have any swallowing impairment. Thirty-three patients were less than 60 years old and were professionally active at the time of surgery. The mean age was 48.5 years old (42-59 years old). Fifteen patients were working in the communications sector, so use of their voice was obligatory. Professional impact and VHI measurements were evaluated.
For patients with professional activities before surgery, 15/33 (45%) continued their activities, whereas 55% had to withdraw from or modify these activities. For patients with communications activities, 6/15 (40%) continued their activities, 4 (26.6%) adapted, and 5 (33.3%) withdrew from their professional activities. The mean VHI value was 51.2. The mean VHI values according to the dysphonic grade (1, 2, and 3) were 36.3, 50.7, and 52.9, respectively. The mean VHI values were 45.6, 58.6, and 53.2, respectively, for patients who pursued their professional activities, withdrew from or adapted their activities, and had no professional activities. Correlations were obtained between VHI and the dysphonic grade (P = .043), cessation of professional activities (P = .034), and the time elapsed since surgery (P = .046). VHI emotional and physical subscale scores were significantly higher for patients who had withdrawn from their professional activities or adapted them.
Supracricoid partial laryngectomy can have a marked social and professional impact. Many patients have to withdraw from professional activities in which vocal involvement is essential. The potential postsurgical social voice impact should be taken into consideration before proposing this surgery, and it is essential to estimate the possible impacts of the vocal handicap according to the patient's professional or other activities.
收集环状软骨上部分喉切除术（SCPL）对嗓音及职业的影响信息。
收集术后12个月以上的生活质量数据，包括专家评定的患者嗓音评估（GRBAS[分级、粗糙度、气息声、无力、紧张]量表）、自我嗓音评估、嗓音障碍指数（VHI）以及社会职业数据。
64例接受SCPL术后的患者接受了评估。手术针对早期T1b或T2声门癌进行。所有患者均无复发、已拔管且无吞咽障碍。33例患者年龄小于60岁，手术时职业活跃。平均年龄为48.5岁（42 - 59岁）。15例患者从事通信行业，因此嗓音使用必不可少。评估职业影响和VHI测量值。
对于术前有职业活动的患者，15/33（45%）继续其活动，而55%不得不退出或改变这些活动。对于从事通信活动的患者，6/15（40%）继续其活动，4例（26.6%）进行了调整，5例（33.3%）退出了职业活动。VHI平均值为51.2。根据嗓音障碍分级（1、2和3级）的VHI平均值分别为36.3、50.7和52.9。对于继续职业活动、退出或调整活动以及无职业活动的患者，VHI平均值分别为45.6、58.6和53.2。VHI与嗓音障碍分级（P = .043）、职业活动停止（P = .034）以及术后时间（P = .046）之间存在相关性。退出或调整职业活动的患者VHI情感和身体子量表得分显著更高。
环状软骨上部分喉切除术可产生显著的社会和职业影响。许多患者不得不退出对嗓音有要求的职业活动。在建议进行该手术之前，应考虑术后潜在的社会嗓音影响，并且根据患者的职业或其他活动评估嗓音障碍的可能影响至关重要。
