Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania.
Department of Otolaryngology - Head and Neck Surgery, Senior Associate Dean for Clinical Academic Specialties, Drexel University College of Medicine, Philadelphia, Pennsylvania.
J Voice. 2021 Jan;35(1):143-150. doi: 10.1016/j.jvoice.2019.07.012. Epub 2019 Jul 27.
Examine incidence of postoperative vocal fold (VF) hemorrhage (PVFH) in patients who underwent microscopic laryngeal surgery and type I thyroplasty and determine the long-term consequences of hemorrhage on the outcome of the surgery.
Retrospective study.
Medical records of patients from a quaternary care laryngology practice who underwent microdirect laryngoscopy (MDL) or type I thyroplasty between November 2015 and December 2018 were reviewed as a consecutive sample. MDL procedures not performed on the VF were excluded. Demographic and medical history data associated with risk of bleeding were collected, and records were reviewed for the incidence of PVFH and long-term consequences of PVFH through Voice Handicap Index-10 (VHI-10) and preoperative and postoperative videostroboscopic findings. We considered each VF surgery as one procedure. Statistical analysis was performed using chi-square analysis for categorical data and a student t test for means. A P value of 0.05 or less was considered significant.
Total 155 patients were enrolled. The patients underwent 182 MDL surgeries, (122 bilateral and 60 unilateral), and 60 Type 1 thyroplasty surgeries (13 bilateral and 47 unilateral). In the MDL group, 34 of 304 procedures (11%) resulted in VFH. In the thyroplasty group, 10 of 73 procedures (13.7%) were associated with PVFH. Bilateral MDL procedures were associated with a higher incidence of PVFH in comparison with unilateral procedures (P= 0.03), but bilateral thyroplasties were not (P= 0.33). None of the demographic factors significantly increased or decreased risk of PVFH. Comparing the difference between preoperative and 3-6 month postoperative VF mucosal function, and preoperative and 3-6 month postoperative VHI-10 in both MDL and thyroplasty groups, no statistically significant difference was found between patients who had experienced PVFH and those who had not.
This is the largest investigation into the incidence and long-term consequences of the PVFH. 11% of the patients in the MDL group experienced PVFH; the vibratory margin of the VF was involved in only 1.3%.; and 13.7 % of the procedures in the thyroplasty group resulted in PVFH. However, PVFH was not associated with significant increase in VHI-10 or decrease in VF vibratory function during 3-6 month postoperative follow-up visits. The incidence of PVFH was related significantly to postoperative phonotrauma and upper respiratory infection, but not to gender, age, history of smoking and alcohol consumption, pulmonary and cardiovascular comorbidities, or pre-existing VF varicosities or ectasias.
检查行显微喉手术和 I 型甲状软骨成形术的患者术后声带（VF）出血（PVFH）的发生率，并确定出血对手术结果的长期影响。
回顾性研究。
回顾了 2015 年 11 月至 2018 年 12 月在四级护理喉科就诊的患者的病历，这些患者接受了微直接喉镜（MDL）或 I 型甲状软骨成形术，作为连续样本。排除了不在 VF 上进行的 MDL 手术。收集了与出血风险相关的人口统计学和病史数据，并通过嗓音障碍指数-10（VHI-10）和术前及术后频闪喉镜检查，评估了 PVFH 的发生率和 PVFH 的长期后果。我们将每个 VF 手术视为一个手术。使用卡方分析进行分类数据的统计分析，使用学生 t 检验进行平均值分析。P 值<0.05 被认为具有统计学意义。
共纳入 155 例患者。这些患者接受了 182 例 MDL 手术（122 例双侧和 60 例单侧）和 60 例 I 型甲状软骨成形术（13 例双侧和 47 例单侧）。在 MDL 组中，304 例手术中有 34 例（11%）发生 VFH。在甲状软骨成形术组中，73 例手术中有 10 例（13.7%）与 PVFH 相关。与单侧手术相比，双侧 MDL 手术与更高的 PVFH 发生率相关（P=0.03），但双侧甲状软骨成形术并非如此（P=0.33）。没有任何人口统计学因素显著增加或降低 PVFH 的风险。比较 MDL 和甲状软骨成形术组中发生和未发生 PVFH 的患者术前和术后 3-6 个月的 VF 黏膜功能以及术前和术后 3-6 个月的 VHI-10 之间的差异，发现两组之间均无统计学意义。
这是对 PVFH 的发生率和长期后果的最大调查。MDL 组 11%的患者发生 PVFH；VF 的振动缘仅受累 1.3%；甲状软骨成形术组 13.7%的手术导致 PVFH。然而，在术后 3-6 个月的随访中，PVFH 与 VHI-10 显著增加或 VF 振动功能下降无关。PVFH 的发生率与术后发声创伤和上呼吸道感染显著相关，但与性别、年龄、吸烟和饮酒史、肺部和心血管合并症或先前存在的 VF 静脉曲张或扩张无关。
