Serra Agostino, Maiolino Luigi, Di Mauro Paola, Licciardello Luisa, Cocuzza Salvatore
ENT Department, University of Catania, Via Santa Sofia 78, 95125, Catania, Italy.
Eur Arch Otorhinolaryngol. 2016 Dec;273(12):4359-4368. doi: 10.1007/s00405-016-4177-0. Epub 2016 Jun 30.
Supracricoid partial laryngectomy is a relevant organ-preserving surgical technique used for the treatment of early or locally advanced laryngeal tumors with an oncologic outcome comparable with that of total laryngectomy. This reconstructive surgery is certainly technically feasible also in the elderly, but the problem is postoperatively as the patient may lack the will and strength to be successfully rehabilitated. The goal was to evaluate functional outcomes, in a maximum follow-up period of ten years from the end of the postoperative follow-up, in a cohort of elderly patients to look at the senile evolution of the laryngeal post surgical function comparing the amount of resection and grade of possible impairment of swallowing and phonatory parameters. A group of 33 patients were selected for a retrospective study aimed at evaluating the long-term evolution of laryngeal functionality after surgery, with the baseline at 5 years from the end of follow-up. All the patients had three-monthly visits for a period up to ten years, during which the objective and subjective swallowing and phonatory parameters were recorded, analyzed and, at the end of the study, compared with baseline. The results suggest that long-term post surgical functional problems may develop also in the neolarynx where the effects of the reconstructive surgery, on speech and swallowing, are largely stabilized. The presence of arytenoid resection had significantly impacted on the occurrence of aspiration even if the overall number of dysphagic patients was not statistically significant compared to baseline.
环状软骨上部分喉切除术是一种相关的保留器官的手术技术，用于治疗早期或局部晚期喉肿瘤，其肿瘤学结果与全喉切除术相当。这种重建手术在老年人中技术上当然也是可行的，但问题在于术后，因为患者可能缺乏成功康复的意愿和力量。目标是在一组老年患者中，从术后随访结束起最长十年的随访期内，评估功能结果，以观察喉手术后功能的老年化演变，比较切除量以及吞咽和发声参数可能受损的程度。选择了一组33例患者进行回顾性研究，旨在评估手术后喉功能的长期演变，以随访结束后5年为基线。所有患者在长达十年的时间里每三个月就诊一次，在此期间记录、分析客观和主观的吞咽及发声参数，并在研究结束时与基线进行比较。结果表明，即使重建手术对言语和吞咽的影响在很大程度上已稳定，但在新喉中术后长期功能问题仍可能出现。即使与基线相比吞咽困难患者的总数无统计学意义，但杓状软骨切除的存在对误吸的发生有显著影响。
