Schweiger Thomas, Roesner Imme, de Faria Soares Rodrigues Isaac, Evermann Matthias, Frick Anna Elisabeth, Denk-Linnert Doris-Maria, Klepetko Walter, Hoetzenecker Konrad
Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
Division of Phoniatrics and Speech Language Therapy, Medical University of Vienna, Vienna, Austria.
J Thorac Cardiovasc Surg. 2022 Jan;163(1):313-322.e3. doi: 10.1016/j.jtcvs.2020.11.155. Epub 2020 Dec 11.
Single-stage laryngotracheal reconstruction (SSLTR) provides a definite surgical treatment for patients with complex glotto-subglottic stenosis. To date, the influence of SSLTR on the functional outcome after surgery has not been analyzed.
A retrospective analysis of all patients receiving a SSLTR between November 2012 and October 2019 was performed. Preoperatively and 3 months postoperatively, patients received a full functional evaluation, including spirometry; voice measurements (eg, fundamental frequency; dynamic range, singing voice range, and perceptual voice evaluation using the Roughness-Breathiness-Hoarseness [RBH] score, and fiberoptic endoscopic evaluation of swallowing [FEES]).
A total of 15 patients with a mean age of 45 ± 17 years underwent SSTLR. Two (13%) patients were men and 13 (87%) were women. The majority of patients (67%) had undergone previous surgical or endoscopic treatment attempts that had failed. At the 3-month follow-up visit, none of the patients had signs of penetration or aspiration in their swallowing examination. Voice measurements revealed a significantly lower fundamental voice frequency (201.0 Hz vs 155.5 Hz; P = .006), whereas voice range (19.1 semitones vs 14.9 semitones; P = .200) and dynamic range (52.5 dB vs 53.0 dB; P = .777) was hardly affected. The median RBH score changed from R1 B0 H1 to R2 B1 H2. In spirometry, breathing capacity increased significantly (peak expiratory flow, 44% vs 87% [P < .001] and mean expiratory flow at 75% of vital capacity, 48% vs 90% [P < .001]). During a median follow-up of 32.5 months (range, 7-88 months), none of the patients developed re-stenosis.
For complex glotto-subglottic stenoses, durable long-term airway patency together with reasonable voice quality and normal deglutition can be achieved by SSLTR.
一期喉气管重建术（SSLTR）为复杂声门-声门下狭窄患者提供了一种明确的外科治疗方法。迄今为止，尚未分析SSLTR对术后功能结局的影响。
对2012年11月至2019年10月期间接受SSLTR的所有患者进行回顾性分析。术前及术后3个月，患者接受全面的功能评估，包括肺活量测定；嗓音测量（如基频；动态范围、歌唱音域，以及使用粗糙度-气息声-嘶哑度[RBH]评分进行的嗓音感知评估，以及纤维喉镜吞咽功能评估[FEES]）。
共有15例平均年龄为45±17岁的患者接受了SSTLR。2例（13%）为男性，13例（87%）为女性。大多数患者（67%）此前曾尝试过手术或内镜治疗但均失败。在3个月的随访中，所有患者在吞咽检查中均无渗透或误吸迹象。嗓音测量显示基频显著降低（201.0 Hz对155.5 Hz；P = .006），而音域（19.1个半音对14.9个半音；P = .200）和动态范围（52.5 dB对53.0 dB；P = .777）几乎未受影响。RBH评分中位数从R1 B0 H1变为R2 B1 H2。在肺活量测定中，呼吸能力显著提高（呼气峰值流量，44%对87%[P < .001]，肺活量75%时的平均呼气流量，48%对90%[P < .001]）。在中位随访32.5个月（范围7 - 88个月）期间，无患者发生再狭窄。
对于复杂的声门-声门下狭窄，SSLTR可实现持久的长期气道通畅，同时伴有合理的嗓音质量和正常吞咽功能。
