Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
Division of Phoniatrics and Speech Language Therapy, Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria.
Eur J Cardiothorac Surg. 2024 Jun 3;65(6). doi: 10.1093/ejcts/ezae105.
Treatment options for benign subglottic stenosis include endoscopic techniques or open surgery. Although endoscopic treatment is less invasive, a considerable proportion of patients develop recurrent stenosis. Endoscopic pretreatments do not exclude patients from a later surgical repair; however, the impact of previous endoscopic treatment attempts on functional outcome after open surgery is unknown.
All patients, who received a cricotracheal resection (CTR) between January 2017 and June 2023 at the Department of Thoracic Surgery, Medical University of Vienna, were included in this retrospective study. Patient characteristics, surgical variables and postoperative outcome including a detailed functional assessment were analysed.
A total of 65 patients received a CTR during the study period, of which 40 were treatment naïve and 25 had a median of 2 (range 1-9) endoscopic pretreatments. Less-invasive voice-sparing CTR or standard CTR were more often possible in treatment-naïve patients. In contrary, pretreated patients regularly required extended procedures (P = 0.049). Three or more endoscopic treatments resulted in a significantly lower mean fundamental frequency (F0) after open repair (P = 0.048). In addition, a trend towards smaller mean sound pressure levels, a higher voice handicap index, higher impairments in RBH scores (roughness, breathing and hoarseness) and a higher dysphagia severity index was found in pretreated patients. The respiratory outcome after surgery was comparable between both groups.
Multiple endoscopic pretreatments lead to worse voice quality after CTR. The impact of prior endoscopic treatment before surgical repair should be considered when discussing treatment options with patients suffering from subglottic stenosis.
良性声门下狭窄的治疗选择包括内镜技术或开放手术。虽然内镜治疗的创伤较小，但相当一部分患者会出现复发性狭窄。内镜预处理并不会使患者无法接受后续的手术修复；然而，先前内镜治疗尝试对开放手术后的功能结果的影响尚不清楚。
本回顾性研究纳入了 2017 年 1 月至 2023 年 6 月期间在维也纳医科大学胸外科接受环状软骨气管切除术（CTR）的所有患者。分析了患者特征、手术变量以及包括详细功能评估在内的术后结果。
研究期间共有 65 名患者接受了 CTR，其中 40 名患者为初次治疗，25 名患者有中位数为 2 次（范围 1-9 次）的内镜预处理。初次治疗患者更常可采用微创、保留嗓音的 CTR 或标准 CTR。相比之下，预处理患者通常需要进行扩展手术（P=0.049）。3 次或更多次内镜治疗会导致开放修复后平均基频（F0）显著降低（P=0.048）。此外，预处理患者的平均声压水平、嗓音障碍指数、RBH 评分（粗糙、呼吸和嘶哑）中的损害程度以及吞咽困难严重程度指数均有升高的趋势。两组患者术后的呼吸结果相当。
多次内镜预处理会导致 CTR 后嗓音质量下降。在与患有声门下狭窄的患者讨论治疗选择时，应考虑手术修复前的内镜治疗史的影响。
