单侧声带麻痹的挽救性治疗：附加注射性喉成形术。
Additional injection laryngoplasty as a salvage treatment for unilateral vocal fold paralysis.
机构信息
Department of Otolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
出版信息
Sci Prog. 2024 Jul-Sep;107(3):368504241276768. doi: 10.1177/00368504241276768.
OBJECTIVES
Injection laryngoplasty (IL) has been widely used as an initial treatment option for unilateral vocal fold paralysis (UVFP). An additional (second) IL is considered a salvage treatment for unsatisfactory outcomes of initial IL resulting from inadequate injection or early resorption of the injection material. This study aims to evaluate the efficacy of additional IL, distinguishing between "salvage" (within 4 months) and "repeated" injections (beyond 4 months), and to analyze prognostic factors for successful outcomes.
METHODS
This retrospective study involved patients who received IL at Asan Medical Center from January 2014 to December 2020. Voice parameters were collected after each procedure, and those who conducted the statistical analysis were blinded to the study subjects. Among the 65 patients who underwent additional IL, 51 patients were enrolled in this study. Postinjection grade, roughness, breathiness, asthenia, strain (GRBAS) scales were used to determine satisfactory treatment outcomes. Success of the additional IL was defined as a postinjection grade of dysphonia score of 0 or 1, with a reduction in grade compared with the preinjection grade.
RESULTS
The mean age of the patients was 61.6 years. Out of a total of 51 patients, 37 were men participating in the study. The odds ratio represents the likelihood of success in the second IL. Improved voice outcome after the additional IL was maintained in 23 (45%) patients. Compared with the failure group, the success group had a longer injection time interval between the initial and additional injection (9.1 vs. 7.4 months, respectively, p = 0.010). The success group had a higher proportion of patients with injection intervals >6 months (73.9% vs. 42.9%, p = 0.026). Logistic regression analysis revealed an injection interval >6 months had an odds ratio of 0.265 (confidence interval: 0.080-0.874, p = 0.029).
CONCLUSIONS
Additional injections would benefit the patients whose voice outcomes are maintained for a longer period (>6 months) after the first injection.
目的
注射性声带成形术（IL）已广泛应用于单侧声带麻痹（UVFP）的初始治疗选择。对于因注射量不足或注射材料早期吸收而导致初始 IL 效果不理想的患者，可进行第二次（额外的）IL 作为挽救性治疗。本研究旨在评估额外 IL 的疗效，区分“挽救性”（4 个月内）和“重复”（4 个月后）注射，并分析成功治疗结局的预测因素。
方法
本回顾性研究纳入了 2014 年 1 月至 2020 年 12 月期间在 Asan 医疗中心接受 IL 的患者。每次手术均采集嗓音参数，进行统计分析的人员对研究对象不知情。在接受额外 IL 的 65 例患者中，有 51 例纳入本研究。注射后使用 GRBAS（嘶哑、粗糙、气息声、乏力、紧张度）量表评估等级，以确定治疗结果是否满意。将额外 IL 成功定义为注射后嗓音障碍评分等级为 0 或 1，与注射前等级相比有所降低。
结果
患者的平均年龄为 61.6 岁。51 例患者中，37 例为男性。优势比代表第二次 IL 成功的可能性。23 例（45%）患者在接受额外 IL 后嗓音状况得到改善。与失败组相比，成功组初始 IL 与额外 IL 之间的注射时间间隔更长（分别为 9.1 个月和 7.4 个月，p=0.010）。成功组中注射间隔>6 个月的患者比例更高（73.9%比 42.9%，p=0.026）。Logistic 回归分析显示，注射间隔>6 个月的优势比为 0.265（95%置信区间：0.080-0.874，p=0.029）。
结论
对于第一次注射后嗓音状况保持较长时间（>6 个月）的患者，额外注射可能有益。
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