早期喉癌治疗后的嗓音康复：一项叙述性综述

文献信息

中文摘要

目的： 早期喉癌，尤其是声门型癌，通常采用放疗或经口CO₂激光显微手术治疗。尽管这些治疗可获得良好的肿瘤学控制，但嗓音损害常作为长期功能问题持续存在，影响生活质量和交流。嗓音治疗已被提出作为解决这些嗓音受限的康复干预措施；然而，目前尚无标准化方案。本叙述性综述旨在综合并批判性评价用于早期喉癌治疗后患者嗓音康复的嗓音治疗技术的现有证据。
方法： 在PubMed/MEDLINE、Scopus、ScienceDirect和Google Scholar中进行了截至2026年5月的全面文献检索。检索策略使用布尔运算符组合了与喉癌和嗓音治疗相关的术语。纳入以英文发表、研究早期喉癌保守治疗（放疗或经口激光显微手术）后嗓音治疗技术、方案或结局的研究。排除综述、非英文出版物、与治疗无关的病例报告以及无法获取全文的论文。
结果： 十五项研究符合纳入标准。大多数研究采用结构化康复方案，结合呼吸、放松、姿势和发声练习，通常进行8-10次。研究结果一致表明，嗓音治疗在嗓音相关生活质量、感知嗓音结局和患者报告的嗓音结局方面提供了具有临床意义的改善，尤其是在短期至中期随访期间。改善在较长随访期内得以维持但部分减弱。尽管在感知和功能方面有改善，声学结局仍存在差异。
结论： 嗓音治疗似乎是早期喉癌保守治疗后改善嗓音结局的有效康复干预措施。结构化生理性嗓音治疗似乎比单纯间接方法更有效。然而，干预方案、结局指标和随访时长的显著异质性限制了研究间的直接比较。未来研究应优先开展大规模对照试验，采用标准化的多维结局指标和长期随访，以更好地界定治疗疗效和持久性。

英文摘要

OBJECTIVES: Early-stage laryngeal cancer, particularly glottic carcinoma, is commonly treated with radiotherapy or transoral CO₂ laser microsurgery. Although these treatments offer favorable oncologic control, voice impairment often persists as a long-term functional concern, affecting quality of life and communication. Voice therapy has been proposed as a rehabilitative intervention to address these voice limitations; however, no standardized protocol currently exists. This narrative review aims to synthesize and critically evaluate the available evidence on voice therapy techniques employed for voice rehabilitation in patients treated for early laryngeal cancer.
METHODS: A comprehensive literature search was conducted in PubMed/MEDLINE, Scopus, ScienceDirect, and Google Scholar through May 2026. The search strategy combined terms related to laryngeal cancer and voice therapy using Boolean operators. Studies published in English that investigated voice therapy techniques, protocols, or outcomes following conservative treatment (radiotherapy or transoral laser microsurgery) for early-stage laryngeal cancer were included. Reviews, non-English publications, case reports unrelated to therapy, and papers without an accessible full text were excluded.
RESULTS: Fifteen studies met the inclusion criteria. Most studies employed structured rehabilitation protocols combining breathing, relaxation, posture, and phonation exercises, typically delivered over 8-10 sessions. Findings consistently indicated that voice therapy provides clinically meaningful improvements in voice-related quality of life, perceptual voice outcomes, and patient-reported voice outcomes, particularly over short- to intermediate-term follow-up periods. Improvements were sustained but partially attenuated over longer follow-up durations. Acoustic outcomes remained variable despite perceptual and functional gains.
CONCLUSION: Voice therapy appears to be an effective rehabilitative intervention for improving voice outcomes following conservative treatment for early laryngeal cancer. Structured physiologic voice therapy seems more effective than indirect approaches alone. However, substantial heterogeneity in intervention protocols, outcome measures, and follow-up durations limits direct comparison across studies. Future research should prioritize large-scale controlled trials with standardized multidimensional outcome measures and long-term follow-up to better delineate treatment efficacy and durability.