Bertelsen Caitlin, Reder Lindsay
USC Caruso Department of Otolaryngology/Head and Neck Surgery, Keck School of Medicine of USC, Los Angeles, California, U.S.A.
Laryngoscope. 2018 Mar;128(3):690-696. doi: 10.1002/lary.26877. Epub 2018 Jan 4.
As phonomicrosurgical techniques have evolved, endoscopic cordectomy (EC) has been used more commonly for early-stage glottic cancer. Patients undergoing more extensive surgery often experience significant postoperative dysphonia for which there is no standard treatment. Surgical options include injection laryngoplasty and thyroplasty. We reviewed the literature to evaluate the efficacy of thyroplasty after EC.
A comprehensive literature search was conducted to identify studies of adults undergoing thyroplasty for dysphonia after EC for glottic cancer. Primary outcomes included voice, as measured subjectively by the voice handicap index (VHI) and objectively by aerodynamics-specifically maximum phonation time (MPT). Secondary outcomes included additional acoustic and aerodynamic measurements, variations in the technical aspects of thyroplasty, and a description of adverse events.
Seven articles met inclusion criteria. Each study allowed 6 to 12 months after EC before performing thyroplasty. General anesthesia frequently was used rather than monitored anesthesia care . Implants varied between centers and were chosen based on surgeon preference. Of the three studies including statistical analysis, one reported improvement in VHI and grade. The second reported improvement in VHI; grade, roughness, breathiness, asthenia, strain; jitter; shimmer; noise-to-harmonic ratio (NHR); and MPT. The third reported improvements in jitter, shimmer, NHR, fundamental frequency, MPT, and sound pressure level. The most frequent adverse events were hematoma, infection, and implant extrusion.
Optimizing voice after EC remains a clinical challenge. Our review suggests that thyroplasty is one potentially beneficial option in appropriately selected patients. More controlled studies are needed to assess efficacy of thyroplasty in this context. Laryngoscope, 128:690-696, 2018.
随着显微外科技术的发展，内镜下声带切除术（EC）已更常用于早期声门癌。接受更广泛手术的患者术后常出现严重的发音障碍，目前尚无标准治疗方法。手术选择包括注射喉成形术和甲状成形术。我们回顾了相关文献，以评估EC术后甲状成形术的疗效。
进行全面的文献检索，以确定关于成年声门癌患者在EC术后因发音障碍接受甲状成形术的研究。主要结局包括嗓音，通过嗓音障碍指数（VHI）主观测量，以及通过空气动力学指标（具体为最长发声时间[MPT]）客观测量。次要结局包括其他声学和空气动力学测量指标、甲状成形术技术方面的差异以及不良事件的描述。
七篇文章符合纳入标准。每项研究均在EC术后6至12个月进行甲状成形术。手术常采用全身麻醉而非监护麻醉。各中心使用的植入物不同，且根据外科医生的偏好选择。在三项包括统计分析的研究中，一项报告VHI和嗓音等级有所改善。第二项报告VHI、嗓音等级、粗糙、气息、无力、紧张、抖动、闪烁、噪声谐波比（NHR）和MPT均有改善。第三项报告抖动、闪烁、NHR、基频、MPT和声压级有所改善。最常见的不良事件是血肿、感染和植入物脱出。
优化EC术后的嗓音仍然是一项临床挑战。我们的综述表明，甲状成形术对适当选择的患者是一种潜在有益的选择。需要更多对照研究来评估甲状成形术在此情况下的疗效。《喉镜》，2018年，128卷：690 - 696页。
