PDF(Pubmed)
Abstract：
OBJECTIVE: Treatment options for benign subglottic stenosis include endoscopic techniques or open surgery. Although endoscopic treatment is less invasive, a considerable proportion of patients develop recurrent stenosis. Endoscopic pretreatments do not exclude patients from a later surgical repair; however, the impact of previous endoscopic treatment attempts on functional outcome after open surgery is unknown.
METHODS: All patients, who received a cricotracheal resection (CTR) between January 2017 and June 2023 at the Department of Thoracic Surgery, Medical University of Vienna, were included in this retrospective study. Patient characteristics, surgical variables and postoperative outcome including a detailed functional assessment were analysed.
RESULTS: A total of 65 patients received a CTR during the study period, of which 40 were treatment naïve and 25 had a median of 2 (range 1-9) endoscopic pretreatments. Less-invasive voice-sparing CTR or standard CTR were more often possible in treatment-naïve patients. In contrary, pretreated patients regularly required extended procedures (P = 0.049). Three or more endoscopic treatments resulted in a significantly lower mean fundamental frequency (F0) after open repair (P = 0.048). In addition, a trend towards smaller mean sound pressure levels, a higher voice handicap index, higher impairments in RBH scores (roughness, breathing and hoarseness) and a higher dysphagia severity index was found in pretreated patients. The respiratory outcome after surgery was comparable between both groups.
CONCLUSIONS: Multiple endoscopic pretreatments lead to worse voice quality after CTR. The impact of prior endoscopic treatment before surgical repair should be considered when discussing treatment options with patients suffering from subglottic stenosis.
METHODS: All patients, who received a cricotracheal resection (CTR) between January 2017 and June 2023 at the Department of Thoracic Surgery, Medical University of Vienna, were included in this retrospective study. Patient characteristics, surgical variables and postoperative outcome including a detailed functional assessment were analysed.
RESULTS: A total of 65 patients received a CTR during the study period, of which 40 were treatment naïve and 25 had a median of 2 (range 1-9) endoscopic pretreatments. Less-invasive voice-sparing CTR or standard CTR were more often possible in treatment-naïve patients. In contrary, pretreated patients regularly required extended procedures (P = 0.049). Three or more endoscopic treatments resulted in a significantly lower mean fundamental frequency (F0) after open repair (P = 0.048). In addition, a trend towards smaller mean sound pressure levels, a higher voice handicap index, higher impairments in RBH scores (roughness, breathing and hoarseness) and a higher dysphagia severity index was found in pretreated patients. The respiratory outcome after surgery was comparable between both groups.
CONCLUSIONS: Multiple endoscopic pretreatments lead to worse voice quality after CTR. The impact of prior endoscopic treatment before surgical repair should be considered when discussing treatment options with patients suffering from subglottic stenosis.
摘要：
目的：良性声门下狭窄的治疗选择包括内镜技术或开放手术。尽管内窥镜治疗的侵入性较小，相当比例的患者出现复发性狭窄。内镜预处理不排除患者接受后期手术修复，然而,既往尝试内镜治疗对开放手术后功能结局的影响尚不清楚.
方法：所有患者，谁在2017年1月1日至2023年6月之间在胸外科接受了环气管切除术（CTR），维也纳医科大学,纳入本回顾性研究。患者特征,分析了手术变量和术后结局,包括详细的功能评估.
结果：在研究期间共有65例患者接受了环气管切除术，其中40例为未接受治疗,25例为中位2例(范围1-9例)内镜预处理.在未接受治疗的患者中，侵入性较少的语音保留CTR或标准CTR更可能。相反,预先治疗的患者定期需要延长手术(p=0.049).三个或更多的内窥镜治疗导致开放修复后的平均基频（F0）显着降低（p=0.048）。此外,平均声压级变小的趋势，较高的语音障碍指数，在接受预治疗的患者中发现更高的RBH评分受损和更高的吞咽困难严重程度指数.两组手术后的呼吸结果具有可比性。
结论：多次内镜预处理导致环状气管切除后语音质量变差。在讨论声门下狭窄患者的治疗方案时，应考虑手术修复前内镜治疗的影响。
方法：所有患者，谁在2017年1月1日至2023年6月之间在胸外科接受了环气管切除术（CTR），维也纳医科大学,纳入本回顾性研究。患者特征,分析了手术变量和术后结局,包括详细的功能评估.
结果：在研究期间共有65例患者接受了环气管切除术，其中40例为未接受治疗,25例为中位2例(范围1-9例)内镜预处理.在未接受治疗的患者中，侵入性较少的语音保留CTR或标准CTR更可能。相反,预先治疗的患者定期需要延长手术(p=0.049).三个或更多的内窥镜治疗导致开放修复后的平均基频（F0）显着降低（p=0.048）。此外,平均声压级变小的趋势，较高的语音障碍指数，在接受预治疗的患者中发现更高的RBH评分受损和更高的吞咽困难严重程度指数.两组手术后的呼吸结果具有可比性。
结论：多次内镜预处理导致环状气管切除后语音质量变差。在讨论声门下狭窄患者的治疗方案时，应考虑手术修复前内镜治疗的影响。
