Grasso Michele, Fusconi Massimo, De Luca Pietro, Camaioni Angelo, Belizzi Mario, Flaccadoro Flavia, Agolli Griselda, Ruoppolo Giovanni, de Vincentiis Marco, Di Maria Domenico, Ralli Massimo, Di Stadio Arianna, Colizza Andrea, Greco Antonio
Department of Sense Organs, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy.
Otolaryngology Unit, Head and Neck Department, San Giovanni-Addolorata Hospital, Rome, Italy.
Indian J Otolaryngol Head Neck Surg. 2023 Sep;75(3):1917-1922. doi: 10.1007/s12070-023-03790-6. Epub 2023 Apr 20.
Early decannulation, performed within the first ten days after supracricoid partial laryngectomy, can result in a more rapid recovery of swallowing function with a semisolid bolus in the short term, about 30 days. We selected 20 patients with squamous cell carcinoma of larynx, who underwent supracricoid laryngectomies: 10 cricohyoidopexy (CHP) and 10 cricohyoidoepiglottopexy (CHEP). Staging was pT2 (10 pts), and pT3 (10 pts). Fiberoptic endoscopic evaluation of swallowing was used to assess postoperative swallowing function after a mean of 12 and 22 days from surgery. A modified PAS score (penetration-aspiration scale) was assigned for subtotal laryngectomies. Decannulation occurred after 6.7 ± 2.1 days. Univariate analysis showed that the type of surgery (CHP or CHEP), pT, resection of one arytenoid, and decannulation time are significantly associated with the 12-day PAS score. The 22-day PAS score is significantly associated with only 3 variables: type of surgery, pT, and resection of one arytenoid. From the data presented, the factors that most delay an effective recovery of swallowing are T3 and the resection of one arytenoid. Early decannulation has been shown statistically to improve PAS score in the short term, but not in the long term.
在环状软骨上部分喉切除术后十天内进行早期拔管，在短期内（约30天）可使吞咽半固体食物的功能恢复得更快。我们选择了20例行环状软骨上喉切除术的喉鳞状细胞癌患者：10例行环舌骨固定术（CHP），10例行环舌会厌固定术（CHEP）。分期为pT2（10例）和pT3（10例）。在术后平均12天和22天时，采用纤维内镜吞咽评估来评估术后吞咽功能。对于次全喉切除术，采用改良的PAS评分（渗透-误吸量表）。拔管在6.7±2.1天之后进行。单因素分析显示，手术类型（CHP或CHEP）、pT、一侧杓状软骨切除以及拔管时间与术后12天的PAS评分显著相关。术后22天的PAS评分仅与三个变量显著相关：手术类型、pT和一侧杓状软骨切除。根据所呈现的数据，最延迟吞咽功能有效恢复的因素是T3和一侧杓状软骨切除。统计学表明，早期拔管在短期内可改善PAS评分，但长期内无此效果。
