Bajaj Y, Uppal S, Sharma R K, Grace A R H, Howard D M, Nicolaides A R, Coatesworth A P
Department of Otolaryngology, York Hospital, UK.
J Laryngol Otol. 2011 Jul;125(7):706-13. doi: 10.1017/S002221511100065X. Epub 2011 Apr 12.
This study aimed to evaluate voice and quality of life after transoral laser resection of early glottic carcinoma.
We studied 19 patients undergoing transoral laser resection of tumour stage (T) one or T2 glottic carcinoma. Laryngeal function was evaluated by video-stroboscopy, vocal function by the Voice Symptom Scale, the grade-roughness-breathiness-asthenia-strain scale and objective phoniatric assessment, and quality of life by the University of Washington Quality of Life questionnaire.
Patients' glottic carcinoma tumour-node-metastasis (TNM) staging was T1 N0 M0 in 14 patients and T2 N0 M0 in five. Overall voice grade, roughness and breathiness were mild to moderate in 84 per cent; asthenia and voice strain were more uniformly distributed, with 15 per cent of patients having normal voice quality. Eight patients developed a glottic web post-operatively; anterior commissure web was significantly associated with worse voice grade (p = 0.05). Seven patients (47 per cent) had a 'mucosal wave' on the operated vocal fold; this was significantly associated with less strain on phonation (p = 0.05). Voice Symptom Scale score was low overall (15 patients (78.9 per cent) scored less than 30). The fundamental frequency and frequency irregularity were normal in nine patients (47.3 per cent); the closed quotient was normal in six (31.5 per cent). The averaged quality of life score was ≥ 90 in 14 patients (73.7 per cent); 18 (94.7 per cent) felt their health-related quality of life was either the same or better post-operatively; and overall quality of life was positive in all.
Transoral laser resection of T1 and T2 glottic carcinoma enables adequate tumour tissue excision with preservation of acceptable vocal function. Most patients' post-operative quality of life is very good. Anterior commissure web formation is associated with poorer vocal function.
本研究旨在评估早期声门癌经口激光切除术后的嗓音及生活质量。
我们研究了19例接受肿瘤分期为T1或T2声门癌经口激光切除术的患者。通过视频频闪喉镜评估喉功能，通过嗓音症状量表、粗糙度-气息声-无力-紧张度量表及客观嗓音评估评估嗓音功能，通过华盛顿大学生活质量问卷评估生活质量。
患者的声门癌肿瘤-淋巴结-转移（TNM）分期中，14例为T1N0M0，5例为T2N0M0。总体嗓音分级、粗糙度及气息声为轻度至中度的患者占84%；无力及嗓音紧张度分布更为均匀，15%的患者嗓音质量正常。8例患者术后出现声门蹼；前联合蹼与较差的嗓音分级显著相关（p = 0.05）。7例患者（47%）手术侧声带出现“黏膜波”；这与发声时较小的紧张度显著相关（p = 0.05）。嗓音症状量表总分总体较低（15例患者（78.9%）得分低于30分）。9例患者（47.3%）的基频及频率不规则性正常；6例患者（31.5%）的闭合商正常。14例患者（73.7%）的平均生活质量得分≥90分；18例患者（94.7%）感觉其与健康相关的生活质量在术后相同或更好；总体生活质量均为阳性。
T1和T2声门癌经口激光切除术能够充分切除肿瘤组织，同时保留可接受的嗓音功能。大多数患者术后生活质量非常好。前联合蹼形成与较差的嗓音功能相关。
