Uno Kosuke, Tomifuji Masayuki, Araki Koji, Tanaka Shingo, Taniai Shinichi, Tanaka Yuya, Kimura Eiko, Ogawa Kaoru, Shiotani Akihiro
Department of Otolaryngology, National Defense Medical College, Saitama, Japan; Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan.
Department of Otolaryngology, National Defense Medical College, Saitama, Japan.
Auris Nasus Larynx. 2020 Oct;47(5):856-863. doi: 10.1016/j.anl.2020.02.007. Epub 2020 Feb 24.
The aim of this study was to evaluate the efficacy and safety of local steroid injections to prevent scar contracture after transoral videolaryngoscopic surgery (TOVS) in hypopharyngeal cancer patients.
Patients were enrolled in this study if they had received a local steroid injection during TOVS and had attended an outpatient clinic after at least three months. All patients were being treated for hypopharyngeal cancer and received a single session of triamcinolone acetonide, injected using a 21-gage needle. Retrospective chart reviews were performed, and the degree of scar contracture, pharyngeal stenosis, vocal fold movements, and adverse events were evaluated. Scar contracture was assessed using a scoring system, which compared the endoscopic findings of treatment and matched pair control groups.
A total of 20 patients received local steroid injections during TOVS and were enrolled in the treatment. Scar contracture was seen in 14 patients (70%); however, the degree of scar contracture was significantly decreased when compared to control cases. Vocal fold immobility was observed in five patients, but no pharyngeal stenosis was noted. Adverse effects, such as postoperative laryngeal chondritis or cervical spondylitis, were seen in three patients who had previously been treated with resection to the muscularis propria or definitive irradiation.
Local steroid injection during TOVS significantly reduced the degree of postoperative scar contracture. However, caution should be used when treating with local steroid injection during TOVS, as this may complicate wound healing in patients who have already received treatment.
本研究旨在评估下咽癌患者经口视频喉镜手术（TOVS）后局部注射类固醇预防瘢痕挛缩的疗效和安全性。
入选本研究的患者为在TOVS期间接受局部类固醇注射且至少三个月后到门诊就诊者。所有患者均接受下咽癌治疗，并使用21号针头注射单剂量曲安奈德。进行回顾性病历审查，评估瘢痕挛缩程度、咽狭窄、声带运动及不良事件。瘢痕挛缩采用评分系统进行评估，该系统比较了治疗组和配对对照组的内镜检查结果。
共有20例患者在TOVS期间接受了局部类固醇注射并纳入治疗。14例患者（70%）出现瘢痕挛缩；然而，与对照病例相比，瘢痕挛缩程度明显减轻。5例患者观察到声带固定，但未发现咽狭窄。3例曾接受固有肌层切除术或根治性放疗的患者出现了术后喉软骨炎或颈椎病等不良反应。
TOVS期间局部注射类固醇可显著降低术后瘢痕挛缩程度。然而，TOVS期间进行局部类固醇注射时应谨慎，因为这可能会使已接受治疗的患者伤口愈合复杂化。
