Cho Jung-Hae, Kim Sang-Yeon, Joo Young-Hoon, Park Young-Hak, Hwang Woo-Seob, Sun Dong-Il
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
J Voice. 2017 Sep;31(5):615-620. doi: 10.1016/j.jvoice.2017.01.003. Epub 2017 Feb 28.
This study aims to investigate the clinical efficacy and safety of immediate intralesional steroid injection in patients undergoing laryngeal microsurgery (LMS) for benign vocal fold lesions (BVFLs).
This is a single-institution, retrospective cohort study.
Patients were divided into two groups according to whether or not they received adjunctive steroid injection after LMS. We evaluated the outcomes using objective, perceptual voice analysis and videostroboscopy. We also analyzed clinical parameters and identified risk factors associated with persistent dysphonia after LMS.
The study included a total of 211 patients with BVFLs (82 men and 129 women), which comprised 136 vocal polyps (64.5%), 49 nodules (23.2%), and 30 cysts (14.2%); 84 patients (39.8 %) had intralesional steroid administration combined with LMS. The overall results for postoperative voice parameters in both groups were significantly improved. On videostroboscopic examination, the rate of recurrent lesions was lower in the group that received adjunctive steroid injection than in the group with only LMS (P = 0.014). In the multivariate analysis, older age (compared to <50 years of age; odds ratio [OR] = 2.697, 95% confidence interval [CI]: 1.300-5.595, P = 0.008) and duration of hoarseness longer than 6 months (compared to <3 months; OR = 2.729, 95% CI: 1.193-6.242, P = 0.017) were identified as independent risk factors associated with persistent dysphonia. Nevertheless, adjunctive steroid injection was associated with a 0.3-fold (OR = 0.345, 95% CI: 0.152-0.784, P = 0.011) lower risk of persistent dysphonia.
Steroid injection combined with LMS in the treatment of BVFLs was safe and associated with improved voice quality.
本研究旨在探讨在接受喉显微手术（LMS）治疗良性声带病变（BVFLs）的患者中，术中即刻病灶内注射类固醇的临床疗效及安全性。
这是一项单机构回顾性队列研究。
根据患者在LMS术后是否接受辅助类固醇注射将其分为两组。我们使用客观、感知性嗓音分析及频闪喉镜检查来评估结果。我们还分析了临床参数，并确定了与LMS术后持续性发音障碍相关的危险因素。
该研究共纳入211例BVFLs患者（82例男性和129例女性），其中包括136例声带息肉（64.5%）、49例小结节（23.2%）和30例囊肿（14.2%）；84例患者（39.8%）在LMS的同时接受了病灶内类固醇注射。两组术后嗓音参数的总体结果均有显著改善。在频闪喉镜检查中，接受辅助类固醇注射的组复发病变率低于仅接受LMS的组（P = 0.014）。在多因素分析中，年龄较大（与<50岁相比；比值比[OR] = 2.697，95%置信区间[CI]：1.300 - 5.595，P = 0.008）以及声音嘶哑持续时间超过6个月（与<3个月相比；OR = 2.729，95% CI：1.193 - 6.242，P = 0.017）被确定为与持续性发音障碍相关的独立危险因素。然而，辅助类固醇注射与持续性发音障碍风险降低0.3倍（OR = 0.345，95% CI：0.152 - 0.784，P = 0.0得11）相关。
类固醇注射联合LMS治疗BVFLs是安全的，且与嗓音质量改善相关。
