Leszczyńska Małgorzata, Wierzbicka Małgorzata, Tokarski Maciej, Szyfter Witold
Department of Otorhinolaryngology, Head and Neck Surgery, Poznań University of Medical Sciences, Przybyszewskiego Street 49, 60-355, Poznan, Poland,
Eur Arch Otorhinolaryngol. 2015 Oct;272(10):2925-31. doi: 10.1007/s00405-014-3244-7. Epub 2014 Aug 21.
The goal of this study was to compare the survival rate and functional outcome of an open partial horizontal laryngectomies, Type IIa and modified Type IIa (OPHL Type IIa and OPHL mType IIa), in treatment of moderately advanced glottic carcinoma. Retrospective analysis. 80 Patients underwent OPHL Type IIa and 27, OPHL modified Type IIa (OPHL mType IIa) between the years 2001 and 2009. Clinical staging was performed according to the UICC criteria (2002). Primary endpoints of study were recurrence rate, and 3- and 5-year survival time. Secondary endpoints were laryngeal functions: respiration, swallowing and voice. There were no significant differences within local and regional recurrence rates, organ preservation rate, 3- and 5-year specific disease survival rates between OPHL Type II and OPHL modified Type IIa. Significantly lower need for temporary (OPHL mType IIa 4/27, OPHL Type IIa 30/80) and permanent tracheostomy (OPHL mType IIa 2/27, OPHL Type IIa 16/80) was found. All but one patient (OPHL Type IIa) achieved unrestricted diet. Significantly differed social eating, this ability gained 25/27 OPHL mType IIa and 54/80 OPHL Type IIa (p < 0.05). Voice handicap index revealed a decrease in quality of life in all areas; OPHL Type IIa and OPHL mType IIa differed significantly (31 and 46 points respectively, p < 0.005). The MPT value (longest pitch) for OPHL Type IIa and OPHL mType IIa lasted 8 s and 10, respectively (p < 0.005). There was no significant difference in oncological outcomes between the two types of OPHL succeeded in the earlier extubation, thus significantly lowering the need for temporary and permanent tracheotomy and providing better long-term swallowing. Although the voice was altered in all observed OPHL patients, modified Type IIa technique proved to be superior to the Type IIa in terms of voice quality. Thus, OPHL modified Type IIa is worth promoting, as long as indications were strictly conformed.
本研究的目的是比较开放性部分水平喉切除术IIa型和改良IIa型(OPHL IIa型和OPHL改良IIa型)治疗中度晚期声门癌的生存率和功能结果。回顾性分析。2001年至2009年期间,80例患者接受了OPHL IIa型手术,27例患者接受了OPHL改良IIa型(OPHL改良IIa型)手术。根据UICC标准(2002年)进行临床分期。研究的主要终点是复发率、3年和5年生存时间。次要终点是喉部功能:呼吸、吞咽和发声。OPHL II型和OPHL改良IIa型在局部和区域复发率、器官保留率、3年和5年特定疾病生存率方面没有显著差异。发现OPHL改良IIa型(27例中有4例)和OPHL IIa型(80例中有30例)对临时气管切开术的需求显著降低,OPHL改良IIa型(27例中有2例)和OPHL IIa型(80例中有16例)对永久性气管切开术的需求显著降低。除1例患者(OPHL IIa型)外,所有患者均实现了无限制饮食。在社交进食方面存在显著差异,27例OPHL改良IIa型患者中有25例具备这种能力,80例OPHL IIa型患者中有54例具备这种能力(p<0.05)。嗓音障碍指数显示所有领域的生活质量均下降;OPHL IIa型和OPHL改良IIa型有显著差异(分别为31分和46分,p<0.005)。OPHL IIa型和OPHL改良IIa型的MPT值(最长音调)分别持续8秒和10秒(p<0.005)。两种类型的OPHL在早期拔管方面的肿瘤学结果没有显著差异,从而显著降低了临时和永久性气管切开术的需求,并提供了更好的长期吞咽功能。尽管所有观察到的OPHL患者的嗓音都发生了改变,但改良IIa型技术在嗓音质量方面被证明优于IIa型。因此,只要严格符合适应症,OPHL改良IIa型值得推广。