切除深度对早期声门病变经口激光显微手术后嗓音结局的影响
Impact of resection depth on voice outcomes following transoral laser microsurgery for early glottic lesions.
文献信息
| PMID | 42922042 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Miha Zabret |
| 作者单位 | Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Slovenia. |
| 期刊 | Radiology and oncology |
| SCI 分区 | Q2 |
| IF | 2.5 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 比较接受最保守的经口激光显微手术（TLM）类型（分类为I型，即上皮下黏膜切除）与完全切除声韧带和/或部分声带肌（II/III型声带切除术）患者的嗓音质量。
患者与方法： 2021年至2024年间，65例具有局限性、临床可疑声带病变的患者被纳入一项单中心、前瞻性纵向研究。其中29例被诊断为高级别上皮内瘤变或早期声门癌（Tis/T1a），并接受TLM治疗。患者被分为两组：第1组（n = 13）包括I型声带切除术后患者，第2组（n = 16）包括II/III型声带切除术后患者。在治疗前以及治疗后1、3和12个月评估主观和客观嗓音结局。
结果： 在12个月时，两组均表现出相当良好的主观嗓音结局，尽管第2组的恢复较慢。感知分析显示，直至6个月时嗓音质量较差，随后两组在12个月时均有改善。视频频闪喉镜检查显示，仅第1组的振动功能呈进行性改善。第1组的声学测量显示F0和s/z比值恢复正常，而jitter和shimmer保持相对稳定，平均强度保持不变。在第2组中，jitter、shimmer、VTI和s/z比值在12个月时仍升高，瘢痕形成更频繁，并存在肌紧张性发声障碍。
结论： 客观嗓音测量显示第1组术后恢复更快，而主观嗓音结局在12个月时两组均显著改善。
英文摘要
BACKGROUND: To compare voice quality in patients undergoing the most conservative transoral laser microsurgery (TLM) types classified as type I (subepithelial mucosal resection), versus complete removal of the vocal ligament and/ or part of the vocal muscle (type II/III cordectomy).
PATIENTS AND METHODS: Between 2021 and 2024, 65 patients with limited, clinically suspicious vocal fold lesions were included in a single-centre, prospective longitudinal study. Among them, 29 were diagnosed with high-grade intraepithelial neoplasia or early-stage glottic carcinoma (Tis/T1a) and were treated with TLM. Patients were divided into two groups: Group 1 (n = 13) included patients after type I cordectomy, and Group 2 (n = 16) included patients after type II/III cordectomy. Subjective and objective voice outcomes were assessed pre-treatment and at 1, 3, and 12 months post-treatment.
RESULTS: At 12 months, both groups demonstrated comparably favourable subjective voice outcomes, although recovery was slower in Group 2. Perceptual analysis revealed poorer voice quality up to 6 months, followed by improvement in both groups at 12 months. Videostroboscopy showed progressive improvement in vibratory function only in Group 1. Acoustic measures in Group 1 demonstrated normalisation of F0 and the s/z ratio, while jitter and shimmer remained relatively stable and mean intensity remained unchanged. In Group 2, jitter, shimmer, VTI, and the s/z ratio remained elevated at 12 months, with more frequent scarring and presence of muscle tension dysphonia.
CONCLUSIONS: Objective voice measures demonstrated faster postoperative recovery in Group 1, whereas subjective voice outcomes improved substantially in both groups by 12 months.