晚期癌症全喉切除术后的手术效果和生活质量——达卡联合军事医院的研究

IF 0.1 Q4 OTORHINOLARYNGOLOGY
M. A. Azad, B. Siddiquee, A. Asaduzzaman, F. Mohsin, M. Hasnat
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Methods: This cross sectional retrospective clinical study was conducted at the Head & Neck Oncology Unit, Combined Military Hospital (CMH), Dhaka. Total 57 candidates were selected. Diagnosis was done by thorough clinical examination, Fibre Optic Laryngoscopy. Contrast Enhanced Computed Tomography (CECT) scan of neck was done except few cases where MRI of neck was done for subtle cartilage erosion was suspected. Examination under anaesthesia, direct larangoscopy and biopsy was done for every cases. Candidates were post chemo-radiated/ radiated biopsy proven recurrent cases, clinically nonfunctional larynx with aspiration and radiologically evident of cartilage erosion. In all cases artificial voice prosthesis was used. All the laryngectomees underwent voice, swallowing, pulmonary and olfactory rehabilitation in laryngectomy club of head & neck oncology unit, CMH Dhaka for a period of 3 months as per standard protocol. 1. Classified ENT Specialist & Head-Neck Surgeon, Dept of ENT and Head-Neck, Surgery, Combined Military Hospital, Chattogram. 2. Professor & Chief, Head & Neck surgery Division, BSMMU, Dhaka. 3. Classified ENT Specialist & Head Neck Surgeon, Dept. of ENT and Head-Neck Surgery, Combined Military Hospital, Cumilla. 4. Classified ENT Specialist & Head – Neck Surgeon, Dept. of ENT and Head-Neck Surgery, Combined Military Hospital, Barishal. 5. Graded ENT Specialist & Head – Neck Surgeon, Dept. of ENT and Head-Neck Surgery, Combined Military Hospital, Bir Uttam Shaeed Mahbub Senanibash, Kholahati, Parbatipur. Address of correspondence: Lieutenant Colonel (Dr.) Muhammad Ali Azad, Classified ENT Spl & Head Neck Surgeon, Dept. of ENT and Head-Neck Surgery, Combined Military Hospital, Chattogram, Bangladesh. Mobile: +8801714056245, E-mail: aliazad101052@gmail.com Introduction: Total laryngectomy is still indispensable procedure in treating advanced or recurrent cancer of larynx and hypopharynx. The larynx has important functions in olfaction and respiration and is more than just an organ of voice production. Its removal requires rehabilitation of all three systems. Perhaps loss of voice is the most distressing to the patients as they loss power of communications and establishment of an acceptable voice is critical for successful psychological adjustment. Multidisciplinary team effort is mandatory to achieve optimal results and good QoL. Prosthetic rehabilitation of voice in laryngectomized patient has become popular after the original article published by Singer and Blom (1980)1. subsequently several high quality voice prosthesis were introduced and have been used successfully such as Panje2, Groningen3 etc. The possibility of achieving good voice is greater with prosthesis comparing with the esophageal voice. Now a days the provox voice prosthesis is the commonest prosthesis used. The first provox voice prosthesis manufactured by Atos Medical, Sweden in 1990. Several version of provox introduced till date. In 2009 the third generation provox vega with smart Inserter was introduced. In our study provox voice prosthesis and vega voice prosthesis were used4-6. Materials and Methods: This cross sectional retrospective study was conducted among the patients suffering from advanced laryngeal cancer had undergone total laryngectomy from Jan 2013 to Jan 2020 in the department of ENT & head-Neck surgery, Combined Military Hospital, Dhaka. Candidates were post chemo-radiated/ radiated biopsy proven recurrent cases, clinically non functional larynx with aspiration and radiologically evident of cartilage erosion. Results: Among the 57 patients 42 of them are using voice prosthesis without any complications till to date. Voice rehabilitation started after wound healing & developed meaningful voice in around 6 weeks. Satisfactory speech & voice outcomes were observed near about 3 months. Voice quality was assessed by multivariate statistical analysis. Excellent voice was observed for 38 patients, good voice for 12 patients, fair voice for 05 patients and poor voice for 02 patients. Troubleshooting like mycotic infection developed in 6 patients which was managed by anti-fungal medication with regular appropriate cleaning, Pharyngocutaneous fistula developed in 5 patients, 3 healed later by pressure dressing and anticholinergic & 1 required exploration and flap reconstruction, 01 developed recurrent stomal stenosis which managed surgically by Y-V advancement. Prosthesis expelled out in 3 cases. 02 cases developed dysphagia due to tonicity of pharyngoesophageal (PE) segment & managed by botox injection. Significantly better voice & swallowing were reported by patients undergone laryngectomy alone in comparison with patients receiving adjuvant radiotherapy & patient undergoing salvage laryngectomy. Conclusion: Awareness should be developed as sacrifice of voice box is no more a permanent comorbidity of total laryngectomy. 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引用次数: 0

摘要

前言:全喉切除术是治疗晚期喉癌的金标准。牺牲声音是该程序最重要的缺点之一。与其他方法相比,使用假肢实现高质量语音的可能性更大。在大多数情况下,喉切除术后使用假体进行语音康复会产生良好的效果。吞咽、肺部和嗅觉康复应由多学科团队管理,以提高生活质量。目的:本研究的目的是观察全喉切除术后语音、吞咽、肺部和嗅觉康复的结果以及生活质量。方法:这项横断面回顾性临床研究在达卡联合军事医院头颈肿瘤科进行。共选出57名候选人。诊断是通过彻底的临床检查,光纤喉镜检查。对颈部进行了对比增强计算机断层扫描(CECT),但少数病例怀疑颈部有轻微软骨侵蚀而进行了MRI检查。所有病例均采用麻醉检查、直接喉镜检查和活检。候选病例为化疗后放射/放射活检证实的复发病例、临床上无功能的喉误吸和放射学上明显的软骨侵蚀。所有病例均使用人工语音假体。根据标准方案,所有喉切除术者在达卡CMH头颈肿瘤科喉切除术俱乐部接受了为期3个月的语音、吞咽、肺部和嗅觉康复。1.联合军事医院耳鼻喉科头颈外科分类专家和头颈外科医生,Chattogram。2.达卡BSMMU头颈外科教授兼主任。3.Cumilla联合军事医院耳鼻喉科和头颈外科分类专家和头颈外科医生。4.巴里沙尔联合军事医院耳鼻喉科头颈外科分类专家和头颈外科医生。5.联合军事医院耳鼻喉科和头颈外科,Bir Uttam Shaeed Mahbub Senanibash,Kholahati,Parbatipur。通讯地址:Muhammad Ali Azad中校(博士),分类五官科Spl和头颈外科医生,联合军事医院耳鼻喉科和头颈外科,孟加拉国查图姆。手机:+8801714056245,邮箱:aliazad101052@gmail.com引言:全喉切除术在治疗晚期或复发性癌症和下咽癌中仍然是必不可少的手术。喉在嗅觉和呼吸方面具有重要功能,它不仅仅是一个发声器官。它的拆除需要恢复所有三个系统。也许失声对患者来说是最痛苦的,因为他们失去了沟通的能力,建立一个可接受的声音对成功的心理调整至关重要。多学科团队的努力是强制性的,以实现最佳结果和良好的生活质量。在Singer和Blom(1980)发表的原创文章1之后,喉切除术患者声音的修复康复变得流行起来。随后又推出了Panje2、Groningen3等几种高质量的人声假体并成功使用。与食道音相比,使用该假体获得良好嗓音的可能性更大。现在,provox语音假体是最常用的假体。瑞典阿托斯医疗公司于1990年制造的第一个provox语音假体。迄今为止推出了几个版本的provox。2009年推出了带有智能插入器的第三代provox-vega。在我们的研究中,使用了provox语音假体和vega语音假体4-6。材料和方法:对2013年1月至2020年1月在达卡联合军事医院耳鼻喉科接受全喉切除术的晚期癌症患者进行横断面回顾性研究。候选病例为化疗后放射/放射活检证实的复发病例、临床上无功能的喉误吸和放射学上明显的软骨侵蚀。结果:57例患者中42例使用了人工发音器,迄今为止未出现任何并发症。声音康复在伤口愈合后开始,并在大约6周内发展出有意义的声音。在近3个月的时间里,观察到了令人满意的言语和语音结果。语音质量通过多变量统计分析进行评估。优音38例,良音12例,尚可音05例,差音02例。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Surgical Outcome and Quality of Life After Total Laryngectomy in Advanced Laryngeal Cancer- A Study in Combined Military Hospital, Dhaka
Introduction: Total laryngectomy is the gold standard treatment for advanced laryngeal cancer. Sacrifice of voice is one of the most important shortcomings of the procedure. Possibility of achieving good quality voice is greater with prosthesis compared to other method. Post laryngectomy voice rehabilitation with prosthesis yield excellent outcome in most of the cases. Swallowing, pulmonary and olfactory rehabilitation should be managed by multidisciplinary team for better quality of life (QoL). Objectives: The purpose of this study was to observe the outcomes of voice, swallowing pulmonary and olfactory rehabilitation and QoL following total laryngectomy. Methods: This cross sectional retrospective clinical study was conducted at the Head & Neck Oncology Unit, Combined Military Hospital (CMH), Dhaka. Total 57 candidates were selected. Diagnosis was done by thorough clinical examination, Fibre Optic Laryngoscopy. Contrast Enhanced Computed Tomography (CECT) scan of neck was done except few cases where MRI of neck was done for subtle cartilage erosion was suspected. Examination under anaesthesia, direct larangoscopy and biopsy was done for every cases. Candidates were post chemo-radiated/ radiated biopsy proven recurrent cases, clinically nonfunctional larynx with aspiration and radiologically evident of cartilage erosion. In all cases artificial voice prosthesis was used. All the laryngectomees underwent voice, swallowing, pulmonary and olfactory rehabilitation in laryngectomy club of head & neck oncology unit, CMH Dhaka for a period of 3 months as per standard protocol. 1. Classified ENT Specialist & Head-Neck Surgeon, Dept of ENT and Head-Neck, Surgery, Combined Military Hospital, Chattogram. 2. Professor & Chief, Head & Neck surgery Division, BSMMU, Dhaka. 3. Classified ENT Specialist & Head Neck Surgeon, Dept. of ENT and Head-Neck Surgery, Combined Military Hospital, Cumilla. 4. Classified ENT Specialist & Head – Neck Surgeon, Dept. of ENT and Head-Neck Surgery, Combined Military Hospital, Barishal. 5. Graded ENT Specialist & Head – Neck Surgeon, Dept. of ENT and Head-Neck Surgery, Combined Military Hospital, Bir Uttam Shaeed Mahbub Senanibash, Kholahati, Parbatipur. Address of correspondence: Lieutenant Colonel (Dr.) Muhammad Ali Azad, Classified ENT Spl & Head Neck Surgeon, Dept. of ENT and Head-Neck Surgery, Combined Military Hospital, Chattogram, Bangladesh. Mobile: +8801714056245, E-mail: aliazad101052@gmail.com Introduction: Total laryngectomy is still indispensable procedure in treating advanced or recurrent cancer of larynx and hypopharynx. The larynx has important functions in olfaction and respiration and is more than just an organ of voice production. Its removal requires rehabilitation of all three systems. Perhaps loss of voice is the most distressing to the patients as they loss power of communications and establishment of an acceptable voice is critical for successful psychological adjustment. Multidisciplinary team effort is mandatory to achieve optimal results and good QoL. Prosthetic rehabilitation of voice in laryngectomized patient has become popular after the original article published by Singer and Blom (1980)1. subsequently several high quality voice prosthesis were introduced and have been used successfully such as Panje2, Groningen3 etc. The possibility of achieving good voice is greater with prosthesis comparing with the esophageal voice. Now a days the provox voice prosthesis is the commonest prosthesis used. The first provox voice prosthesis manufactured by Atos Medical, Sweden in 1990. Several version of provox introduced till date. In 2009 the third generation provox vega with smart Inserter was introduced. In our study provox voice prosthesis and vega voice prosthesis were used4-6. Materials and Methods: This cross sectional retrospective study was conducted among the patients suffering from advanced laryngeal cancer had undergone total laryngectomy from Jan 2013 to Jan 2020 in the department of ENT & head-Neck surgery, Combined Military Hospital, Dhaka. Candidates were post chemo-radiated/ radiated biopsy proven recurrent cases, clinically non functional larynx with aspiration and radiologically evident of cartilage erosion. Results: Among the 57 patients 42 of them are using voice prosthesis without any complications till to date. Voice rehabilitation started after wound healing & developed meaningful voice in around 6 weeks. Satisfactory speech & voice outcomes were observed near about 3 months. Voice quality was assessed by multivariate statistical analysis. Excellent voice was observed for 38 patients, good voice for 12 patients, fair voice for 05 patients and poor voice for 02 patients. Troubleshooting like mycotic infection developed in 6 patients which was managed by anti-fungal medication with regular appropriate cleaning, Pharyngocutaneous fistula developed in 5 patients, 3 healed later by pressure dressing and anticholinergic & 1 required exploration and flap reconstruction, 01 developed recurrent stomal stenosis which managed surgically by Y-V advancement. Prosthesis expelled out in 3 cases. 02 cases developed dysphagia due to tonicity of pharyngoesophageal (PE) segment & managed by botox injection. Significantly better voice & swallowing were reported by patients undergone laryngectomy alone in comparison with patients receiving adjuvant radiotherapy & patient undergoing salvage laryngectomy. Conclusion: Awareness should be developed as sacrifice of voice box is no more a permanent comorbidity of total laryngectomy. Excellent voice can be developed by insertion of voice prosthesis as well as swallowing pulmonary and olfactory rehabilitation following laryngectomy for better of QoL.
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