Safia Alaa, Abd Elhadi Uday, Roch Mohamad, Kassem Kenan, Safiya Rabia, Zubeidat Ahmed, Nofal Nader, Heib Anwar, Merchavy Shlomo, Bishara Taiser
Department of Otolaryngology, Head & Neck Surgery Unit, Rebecca Ziv Medical Center, Safed.
True Doctor, Research Wing, Israel.
Int J Surg. 2024 Nov 1;110(11):7281-7310. doi: 10.1097/JS9.0000000000001978.
Unilateral vocal fold paralysis (UVFP) significantly impairs vocal function, affecting patients' quality of life. Injection laryngoplasty, a primary treatment modality for UVFP, varies in effectiveness based on the material used, injection volume, and procedural nuances. This study aims to systematically analyze how these factors influence treatment outcomes to optimize intervention strategies.
The authors conducted a comprehensive meta-analysis and meta-regression using data extracted from 82 studies identified through a robust literature search on databases including PubMed, Scopus, and Web of Science, up to 13 February 2024. Eligible studies were single-armed observational or experimental that reported pre and postoperative data on UVFP patients undergoing their first injection laryngoplasty. The primary outcomes analyzed included maximum phonation time, harmonics-to-noise ratio, fundamental frequency, jitter, shimmer, and subjective voice measures such as the Voice Handicap Index and GRBAS scale components.
The meta-analysis revealed significant improvements in maximum phonation time (MPT) and harmonics-to-noise ratio (HNR) post-injection, with variability in outcomes influenced by injection material and procedural techniques. Meta-regression identified the injection volume and the timing of the procedure as significant predictors of MPT and HNR outcomes, respectively. Materials such as polydimethylsiloxane (PDMS) and autologous fat significantly improved MPT and reduced the grade of dysphonia and roughness, respectively. The type of injection material, volume, and approach was crucial in reducing symptoms of voice handicap and enhancing the overall vocal quality.
Injection laryngoplasty significantly improves vocal outcomes in UVFP patients. The choice of injection material, volume, and timing of the intervention play pivotal roles in determining the effectiveness of the procedure. Tailored treatment approaches based on these factors are recommended to enhance therapeutic efficacy and patient satisfaction.
单侧声带麻痹（UVFP）会严重损害发声功能，影响患者的生活质量。注射喉成形术是UVFP的主要治疗方式，其效果因所用材料、注射量和手术细节的不同而有所差异。本研究旨在系统分析这些因素如何影响治疗效果，以优化干预策略。
作者通过对包括PubMed、Scopus和Web of Science在内的数据库进行全面的文献检索，截至2024年2月13日，从82项研究中提取数据，进行了全面的荟萃分析和荟萃回归。符合条件的研究为单臂观察性或实验性研究，报告了接受首次注射喉成形术的UVFP患者的术前和术后数据。分析的主要结果包括最大发声时间、谐波噪声比、基频、抖动、闪烁以及主观声音指标，如嗓音障碍指数和GRBAS量表成分。
荟萃分析显示，注射后最大发声时间（MPT）和谐波噪声比（HNR）有显著改善，结果的变异性受注射材料和手术技术影响。荟萃回归确定注射量和手术时机分别是MPT和HNR结果的显著预测因素。聚二甲基硅氧烷（PDMS）和自体脂肪等材料分别显著改善了MPT并降低了发音障碍和粗糙度等级。注射材料的类型、体积和方法对于减轻嗓音障碍症状和提高整体嗓音质量至关重要。
注射喉成形术显著改善了UVFP患者的发声结果。注射材料的选择、体积和干预时机在决定手术效果方面起着关键作用。建议根据这些因素制定个性化的治疗方法，以提高治疗效果和患者满意度。
