Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. Listopadu 1790, 708 52, Ostrava, Czech Republic.
Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.
Eur Arch Otorhinolaryngol. 2021 Aug;278(8):2899-2906. doi: 10.1007/s00405-021-06751-3. Epub 2021 Mar 18.
To evaluate voice quality evolution after a transoral laser cordectomy (TLC) for precancerous lesions and early glottic cancer.
This prospective study enrolled 18 patients scheduled for TLC for high-grade dysplasia, Tis, T1, and T2 glottic squamous cell cancers, from May 2017 to March 2020. Patients were grouped according to the extent of TLC: Group I (n = 11, 61.1%): unilateral subepithelial or subligamental cordectomy; Group II (n = 7, 38.9%): unilateral transmuscular, total, or extended cordectomy. Voice quality parameters, including dysphonia grade (G), roughness (R), breathiness (B), maximal phonation time (MPT), jitter, and shimmer, were evaluated before, and at 6 weeks and 6 months after the TLC.
In Group I, the degree of G and R items remained without substantial improvement 6 weeks after surgery; however, improved above the pre-surgery level up to 6 months after surgery. The MPT, jitter, and shimmer did not change significantly at 6 weeks or 6 months post-TLC. In Group II, G, R, and B remained significantly impaired even 6 months post-surgery. Jitter, and shimmer worsened at 6 weeks, but reached preoperative levels at 6 months post-surgery. MPT was significantly worse at 6 weeks and remained deteriorated at 6 months post-surgery. All measured parameters were significantly worse in Group II than in Group I at 6 weeks and 6 months post-surgery. No patient required a phonosurgical procedure.
After a TLC, voice quality evolution depended on the extent of surgery. It did not improve at 6 weeks post-surgery. Improvements in less extent cordectomies occurred between 6 weeks and 6 months post-surgery. Understanding voice development over time is important for counseling patients when considering phonosurgical procedures.
评估经口激光声带切除术（TLC）治疗癌前病变和早期声门癌后嗓音质量的演变。
本前瞻性研究纳入了 2017 年 5 月至 2020 年 3 月期间因高级别不典型增生、Tis、T1 和 T2 声门鳞状细胞癌而计划行 TLC 的 18 例患者。根据 TLC 的范围将患者分为两组：I 组（n=11，61.1%）：单侧黏膜下或黏膜下声带切除术；II 组（n=7，38.9%）：单侧跨肌、全声带或扩展声带切除术。在术前、术后 6 周和 6 个月评估嗓音质量参数，包括声扰度分级（G）、粗糙性（R）、气息声（B）、最大发音时间（MPT）、微扰和振幅微扰。
在 I 组中，术后 6 周时 G 项和 R 项的严重程度仍无明显改善；但在术后 6 个月时改善到高于术前水平。MPT、微扰和振幅微扰在术后 6 周或 6 个月时无明显变化。在 II 组中，即使在术后 6 个月时，G、R 和 B 仍明显受损。微扰和振幅微扰在术后 6 周时恶化，但在术后 6 个月时达到术前水平。MPT 在术后 6 周和 6 个月时明显较差。所有测量参数在术后 6 周和 6 个月时在 II 组均显著差于 I 组。无患者需要行嗓音手术。
TLC 后，嗓音质量的演变取决于手术范围。术后 6 周时无改善。在较小范围的声带切除术患者中，6 周和 6 个月之间出现改善。了解随着时间的推移嗓音的发展对于考虑嗓音手术的患者咨询非常重要。
