Abstract：
OBJECTIVE: The aim of this study is to evaluate functional outcomes in terms of decannulation rate and quality of life of patients affected by PGS (Grades I-IV) treated only by transoral CO2 laser microsurgery (TOLMS) in two tertiary centers.
METHODS: An observational retrospective study was carried out, enrolling 22 patients affected by PGS who were treated by a transoral approach at two tertiary referral centers. Surgical treatment included TOLMS with tailored laser resection of the scar tissue combined with posterior cordotomy, resurfacing of the raw area with mucosal microflap, or placement of a Montgomery T-tube or Keel stent. All patients were evaluated and staged preoperatively and postoperatively, at least 6 months after the surgery. Functional outcomes were objectively evaluated by the Airway-Dysphonia-Voice-Swallowing (ADVS) staging system, Voice Handicap Index-30 (VHI-30), and Eating Assessment Tool-10 (EAT-10) questionnaires.
RESULTS: Quality of life significantly improved as measured by the VHI-30 questionnaire with a median variation of - 31.0 (p = 0.003), the EAT-10 with a median variation of - 4.0 (p = 0.042), and the ADVS with a median variation of - 3.5 (p < 0.001). No significant changes were observed in swallowing scores. We were able to decannulate 7 of 9 patients (almost 80%) with previous tracheotomy.
CONCLUSIONS: In conclusion, even if there is still no general agreement on an exact therapeutic algorithm to treat PGS, our results confirm that transoral surgery, in terms of scar tissue removal, combined in selected patients with posterior cordotomy and pedicled local flaps and/or placement of stents, represents a safe and effective surgical approach even for more severe PGS.
METHODS: An observational retrospective study was carried out, enrolling 22 patients affected by PGS who were treated by a transoral approach at two tertiary referral centers. Surgical treatment included TOLMS with tailored laser resection of the scar tissue combined with posterior cordotomy, resurfacing of the raw area with mucosal microflap, or placement of a Montgomery T-tube or Keel stent. All patients were evaluated and staged preoperatively and postoperatively, at least 6 months after the surgery. Functional outcomes were objectively evaluated by the Airway-Dysphonia-Voice-Swallowing (ADVS) staging system, Voice Handicap Index-30 (VHI-30), and Eating Assessment Tool-10 (EAT-10) questionnaires.
RESULTS: Quality of life significantly improved as measured by the VHI-30 questionnaire with a median variation of - 31.0 (p = 0.003), the EAT-10 with a median variation of - 4.0 (p = 0.042), and the ADVS with a median variation of - 3.5 (p < 0.001). No significant changes were observed in swallowing scores. We were able to decannulate 7 of 9 patients (almost 80%) with previous tracheotomy.
CONCLUSIONS: In conclusion, even if there is still no general agreement on an exact therapeutic algorithm to treat PGS, our results confirm that transoral surgery, in terms of scar tissue removal, combined in selected patients with posterior cordotomy and pedicled local flaps and/or placement of stents, represents a safe and effective surgical approach even for more severe PGS.
摘要：
目的：本研究的目的是评估两个三级中心仅接受经口CO2激光显微手术（TOLMS）治疗的PGS（I-IV级）影响患者的功能结局和生活质量。
方法：进行了一项观察性回顾性研究，在两个三级转诊中心接受经口入路治疗的22例受PGS影响的患者。手术治疗包括TOLMS和定制的激光切除瘢痕组织联合后索切开术。用粘膜微皮瓣修复原始区域，或放置蒙哥马利T型管或龙骨支架。对所有患者进行术前、术后评估和分期,手术后至少6个月。通过气道-发声障碍-语音-吞咽（ADVS）分期系统客观评估功能结果，语音障碍指数-30(VHI-30),和饮食评估工具-10(EAT-10)问卷。
结果：通过VHI-30问卷测量，生活质量显着改善，中位变异为-31.0（p=0.003），EAT-10的中值变异为-4.0(p=0.042)，和ADVS的中值变异为-3.5(p<0.001)。在吞咽评分中没有观察到显著变化。我们能够在先前的气管切开术中对9例患者中的7例（近80％）进行拔管。
结论：结论：即使在治疗PGS的确切治疗算法上仍然没有普遍的共识，我们的结果证实了经口手术，在去除疤痕组织方面，在选定的患者中，联合后索切开术和带蒂局部皮瓣和/或支架放置，即使对于更严重的PGS，也是一种安全有效的手术方法。
方法：进行了一项观察性回顾性研究，在两个三级转诊中心接受经口入路治疗的22例受PGS影响的患者。手术治疗包括TOLMS和定制的激光切除瘢痕组织联合后索切开术。用粘膜微皮瓣修复原始区域，或放置蒙哥马利T型管或龙骨支架。对所有患者进行术前、术后评估和分期,手术后至少6个月。通过气道-发声障碍-语音-吞咽（ADVS）分期系统客观评估功能结果，语音障碍指数-30(VHI-30),和饮食评估工具-10(EAT-10)问卷。
结果：通过VHI-30问卷测量，生活质量显着改善，中位变异为-31.0（p=0.003），EAT-10的中值变异为-4.0(p=0.042)，和ADVS的中值变异为-3.5(p<0.001)。在吞咽评分中没有观察到显著变化。我们能够在先前的气管切开术中对9例患者中的7例（近80％）进行拔管。
结论：结论：即使在治疗PGS的确切治疗算法上仍然没有普遍的共识，我们的结果证实了经口手术，在去除疤痕组织方面，在选定的患者中，联合后索切开术和带蒂局部皮瓣和/或支架放置，即使对于更严重的PGS，也是一种安全有效的手术方法。
