Thrasyvoulou Giannis, Vlastarakos Petros V, Thrasyvoulou Michael, Sismanis Aristides
Department of Otolaryngology, Nicosia General Hospital, Nicosia, Cyprus.
Ear Nose Throat J. 2018 Apr-May;97(4-5):E31-E35. doi: 10.1177/0145561318097004-502.
We conducted a cross-sectional study to compare the horizontal and vertical methods used in the surgical closure of the neo-pharynx after total laryngectomy in terms of their effect on swallowing function, swallowing-related quality of life (QOL), and overall QOL. We also assessed the potential influence of age (≤64 vs. ≥65 yr) and the type of treatment modality (primary, salvage, or total laryngectomy with radiotherapy) on outcomes. Our final study population was made up of 34 patients-31 men and 3 women, aged 49 to 89 years (mean: 66.8)-who had undergone a total laryngectomy. One year after surgery, all patients were asked to complete the M.D. Anderson dysphagia inventory (MDADI), which quantifies swallowing function and swallowing-related QOL, and the University of Washington quality-of-life questionnaire (UW-QOL), which quantifies overall QOL. Of the 34 patients, 16 had undergone a horizontal surgical closure of their neo-pharynx and 18 a vertical closure. According to the MDADI, patients in the horizontal group experienced significantly better swallowing function/QOL; the mean composite MDADI scores were 91.5 in the horizontal group and 68.3 in the vertical group (p = 0.005). We found no significant difference in terms of overall QOL, as the respective mean UW-QOL scores were 81.0 and 80.8 (p = 0.93). The population correlation coefficient was positive in both groups, but more so in the horizontal group (ρ = 0.876 and ρ = 0.676). Neither age nor the type of treatment modality employed influenced swallowing function/QOL (p = 0.10, p = 0.78) or overall QOL (p = 0.08, p = 0.59). We conclude that horizontal closure of the neo-pharynx is superior to vertical closure in terms postoperative swallowing function/QOL but not overall QOL.
我们开展了一项横断面研究，比较全喉切除术后新咽手术关闭采用的水平法和垂直法对吞咽功能、吞咽相关生活质量（QOL）以及总体生活质量的影响。我们还评估了年龄（≤64岁与≥65岁）和治疗方式类型（初次治疗、挽救性治疗或全喉切除联合放疗）对结局的潜在影响。我们最终的研究人群由34例接受了全喉切除术的患者组成，其中31例男性，3例女性，年龄在49至89岁之间（平均：66.8岁）。术后一年，所有患者均被要求完成量化吞咽功能和吞咽相关生活质量的MD安德森吞咽量表（MDADI）以及量化总体生活质量的华盛顿大学生活质量问卷（UW-QOL）。在这34例患者中，16例行新咽水平手术关闭，18例行垂直手术关闭。根据MDADI，水平组患者的吞咽功能/生活质量明显更好；水平组的MDADI综合平均得分是91.5，垂直组是68.3（p = 0.005）。我们发现总体生活质量方面无显著差异，因为UW-QOL各自的平均得分分别为81.0和80.8（p = 0.93）。两组的总体相关系数均为正，但水平组更高（ρ = 0.876和ρ = 0.676）。年龄和所采用的治疗方式类型均未影响吞咽功能/生活质量（p = 0.10，p = 0.78）或总体生活质量（p = 0.08，p = 0.59）。我们得出结论，就术后吞咽功能/生活质量而言，新咽水平关闭优于垂直关闭，但在总体生活质量方面并非如此。
