Comparison of long-term functional results between standard supracricoid laryngectomy and modified technique with sternohyoid muscle,

Abstract Introduction: Laryngeal cancer is the most common cancer of the upper respiratory tract. The main methods of treatment included surgery (partial laryngectomy and total laryngectomy) and radiation therapy. Laryngeal dysfunction is seen after both treatment modalities. Objective: The aim of the study is to compare postoperative functional results of the standard supracricoid partial laryngectomy technique and a modified supracricoid partial laryngectomy technique using the sternohyoid muscle. Methods: In total, 29 male patients (average years 58.20 ± 9.00 years; range 41-79 years) with laryngeal squamous cell carcinoma who underwent supra cricoid partial laryngectomy were included. The patients were divided into two groups in terms of the surgical techniques. In Group A, all patients underwent standard supracricoid partial laryngectomy technique between January 2007 and November 2011. In Group B, all patients underwent modified supracricoid partial laryngectomy between August 2010 and November 2011. Fiberoptic endoscopic evaluation of swallowing test, short version of the voice handicap index scores, and the MD Anderson dysphagia inventory, the time of oral feeding and the decanulation of the patients after surgery of each groups were compared. Results: The mean maximum phonation time was 8.68 ± 4.21 s in Group A and 15.24 ± 6.16 s in Group B (p > 0.05). The S/Z (s/s) ratio was 1.23 ± 0.35 in Group A and 1.08 ± 0.26 in Group B (p > 0.05); the voice handicap index averages were 9.86 ± 4.77 in Group A and 12.42 ± 12.54 in Group B (p > 0.05); the fiberoptic endoscopic evaluation of swallowing test averages were calculated as 12.73 ± 3.08 in Group A and 13.64 ± 1.49 in Group B (p > 0.05). In the MD Anderson dysphagia inventory, evaluation of swallowing, the emotional, physical, and functional scores were 29.21 ± 4.11, 32.21 ± 6.85, and 20.14 ± 2.17 in the Group B, and 29.20 ± 2.54, 32.4 ± 4.79, and 19 ± 1.92 in Group A, respectively. Conclusion: Although there is no statistical difference in functional outcome comparisons, if rules are adhered to in preoperative patient selection, modified supracricoid partial laryngectomy can be applied safely and meaningful gains can be achieved in functional outcomes.

摘要：喉癌（Laryngeal cancer）是上呼吸道最常见的恶性肿瘤。其主要治疗手段包括手术（喉部分切除术与喉全切除术）与放射治疗。两种治疗方式术后均会出现喉功能障碍。本研究的目的为对比标准环上部分喉切除术（standard supracricoid partial laryngectomy）与采用胸骨舌骨肌的改良环上部分喉切除术（modified supracricoid partial laryngectomy using the sternohyoid muscle）的术后功能效果。
方法：本研究共纳入29例男性喉鳞状细胞癌（laryngeal squamous cell carcinoma）患者，平均年龄为58.20±9.00岁，年龄范围41~79岁，所有患者均接受了环上部分喉切除术。根据手术方式将患者分为两组：A组纳入2007年1月至2011年11月期间接受标准环上部分喉切除术的全部患者；B组纳入2010年8月至2011年11月期间接受改良环上部分喉切除术的全部患者。对比两组患者术后的纤维喉镜吞咽功能检查（fiberoptic endoscopic evaluation of swallowing test）评分、简化版嗓音障碍指数（short version of the voice handicap index）评分、MD安德森吞咽困难量表（MD Anderson dysphagia inventory）评分、经口进食恢复时间以及拔管情况。
结果：A组患者的平均最长发声时间为8.68±4.21秒，B组为15.24±6.16秒（p>0.05）；A组的S/Z（s/s）比值为1.23±0.35，B组为1.08±0.26（p>0.05）；A组的简化版嗓音障碍指数平均得分为9.86±4.77，B组为12.42±12.54（p>0.05）；A组的纤维喉镜吞咽功能检查平均得分为12.73±3.08，B组为13.64±1.49（p>0.05）。在MD安德森吞咽困难量表中，B组的吞咽评估、情绪、躯体与功能维度得分分别为29.21±4.11、32.21±6.85与20.14±2.17，A组对应得分分别为29.20±2.54、32.4±4.79与19±1.92。
结论：尽管两组的功能结局无统计学差异，但若严格遵循术前患者筛选标准，采用胸骨舌骨肌的改良环上部分喉切除术可安全开展，并能在功能结局上获得有临床意义的改善。