性别肯定照护中喉部手术的时机：单机构回顾

文献信息

中文摘要

目的： 通过分析以下内容，了解喉部手术在跨性别和性别多元（TGD）患者性别肯定手术（GAS）顺序中的位置：（1）所接受GAS的数量和类型，（2）所接受GAS的时间顺序，以及（3）喉部手术的时机是否影响功能性嗓音结局。
方法： 对在单一机构耳鼻咽喉科因主要诊断为“性别烦躁”而接受喉部手术的成年患者进行回顾性病历审查。仅接受嗓音治疗（VT）的TGD患者作为对照纳入。审查病历以获取所有已实施的GAS以及嗓音相关问卷（VHI-10和TWVQ）。
结果： 72例患者为喉部手术后状态，平均（标准差[SD]）年龄为35（13）岁；62例接受嗓音女性化手术，10例接受嗓音男性化手术。平均（SD）而言，患者接受2.61（1.52）项GAS，包括1.42（0.64）项喉部手术、0.34（0.70）项面部手术、0.43（0.58）项胸部手术和0.44（0.58）项下部手术。29例仅接受喉部手术。在43例接受多项GAS的患者中，7例首先接受喉部手术，7例在其他GAS之间接受喉部手术，29例最后接受喉部手术（P < 0.0001）。首先接受喉部手术的患者术前TWVQ评分更高（P = 0.018）。按喉部手术时机比较，未观察到术后或TWVQ变化评分存在显著差异。46例VT后状态患者作为对照纳入，包括40例跨女性化和6例跨男性化患者。手术组与VT组在干预后（P = 0.0007）和变化（P = 0.0074）TWVQ评分方面存在显著差异。
结论： 喉部手术在治疗嗓音不一致方面非常有效。大多数患者最后接受喉部手术。然而，喉部手术的时机并不影响嗓音结局。需要提高对嗓音手术作为性别烦躁有效选择的认识，尤其考虑到喉部手术面临的诸多障碍（保险限制、专科外科医生稀缺、地理差异等）。
证据等级： 回顾性队列研究，单机构病历审查。

英文摘要

OBJECTIVES: To understand where laryngeal surgery falls in the order of gender-affirming surgeries (GAS) for transgender and gender diverse (TGD) patients, by analyzing: (1) number and types of GAS pursued, (2) chronological order of GAS pursued, and (3) whether the timing of laryngeal surgery impacts functional voice outcomes METHODS: Retrospective chart review of adult patients undergoing laryngeal surgery within a single institution's Otolaryngology department for a primary diagnosis of "Gender Dysphoria." TGD patients pursuing voice therapy (VT) only were enlisted as controls. Charts were reviewed for all GAS performed and voice-related questionnaires (VHI-10 and TWVQ).
RESULTS: Seventy-two patients status post laryngeal surgery with an average (standard deviation [SD]) age of 35 (13) years; 62 underwent vocal feminization, and 10 underwent vocal masculinization. On average (SD), patients underwent 2.61 (1.52) GAS, consisting of 1.42 (0.64) laryngeal surgeries, 0.34 (0.70) facial surgeries, 0.43 (0.58) top surgeries, and 0.44 (0.58) bottom surgeries. Twenty-nine pursued laryngeal surgery only. Among the 43 who underwent multiple GAS, seven pursued laryngeal surgery first, seven pursued laryngeal surgery between other GAS, and 29 pursued laryngeal surgery last (P < 0.0001). Patients who pursued laryngeal surgery first had higher preoperative TWVQ scores (P = 0.018). No significant differences in postoperative or delta TWVQ scores by timing of laryngeal surgery were observed. Forty-six patients status post VT were enrolled as controls, consisting of 40 transfeminine and six transmasculine patients. Significant differences were identified in post-intervention (P = 0.0007) and delta (P = 0.0074) TWVQ scores between surgery and VT cohorts.
CONCLUSION: Laryngeal surgery is highly effective in treating vocal incongruence. Most patients pursue laryngeal surgery last. However, timing of laryngeal surgery does not affect voice outcomes. There is a need to increase awareness of voice surgery as an effective option for gender dysphoria, especially considering the many barriers to laryngeal surgery (insurance limitations, scarcity of specialized surgeons, geographic disparities, etc).
LEVEL OF EVIDENCE: Retrospective cohort study, single institution chart review.