接受喉直達鏡顯微手術病患之相關因子及術後追蹤

Relevant Factors of Patient Receiving Laryngomicrosurgery and Post-Operative Outcome

蔡佳憲(Chia-Hsien Tsai) ； 何豐名(Feng-Min Ho) ； 鄭健禹(Chien-Yu Cheng) ； 鄭爵儀(Chueh-Yi Cheng)

《台灣耳鼻喉頭頸外科雜誌》 49卷1期 (2014/03) Pp. 41-46

https://doi.org/10.6286/2014.49.1.41

摘要

目的：聲帶息肉或結節常見於聲音沙啞者，經休養及口服藥物無效後，醫師常藉由喉直達鏡顯微手術改善聲音品質。這群手術的病患中，可能有某些因子或型態頻繁出現。由此提供臨床醫師在選取病患與解釋病情時有所參考。方法：回顧2009年7月至2013年2月期間接受喉直達鏡顯微手術的病人，但排除喉部惡性腫瘤患者。分析病患之各相關因子所佔比率，如性別、年齡層、職業、過往病史、主訴沙啞時長等差異，以及術前纖維內視鏡臨床診斷、術後病理組織長短、病理報告特殊性及術後聲音恢復情形之相關性。結果：111名接受手術的病例最常發生在中年族群（40-59y/o; 50.1%），其中女性（63.1%）多於男性。女性族群又以家管（38.6%）且不抽菸（82.9%）為主，男性族群則以工業（46.3%）且抽菸（75.6%）為主。總群體、男性、女性在青年、壯年、中年與老年族群分布狀況並無差異，型態都皆以中年最多（50.5%、58.5%、44.3%），其次為壯年（35.1%、29.2%、40%）。統計各類過往病史中，以抽菸為最多38.7%。術前沙啞時長集中在半年內為主。臨床診斷為息肉、結節、囊腫、混合性、白斑等病灶型態中，以息肉佔多數（46.8%），然而比較息肉及結節在最大病理標本之分佈有顯著差異（p＜0.001）。術後追蹤超過4周聲音仍然沙啞者佔9.7%，術後因聲帶病灶再次復發二次手術者佔7.8%。結論：病患接受喉直達鏡顯微手術時，因族群職業不同，接受喉直達鏡顯微手術意願也不同。接受手術的病患年齡集中在中年。女性以家管不抽菸為主，男性以工人抽菸居多。臨床診斷息肉或結節時病灶之大小可作為輔助判定依據。藉由喉直達鏡顯微手術切除凸起型聲帶病灶改善聲音品質為有效而安全的選擇。

關鍵字

沙啞 ； 聲帶息肉 ； 聲帶結節 ； 喉直達鏡顯微手術

並列摘要

BACKGROUND: Vocal lesions such as polyps or nodules are commonly found among husky patients. After resting or oral pills, some patients did not recover from illness, and ENT specialists might perform laryngomicrosurgery (LMS) to improve quality of patient's voice. The patients received LMS often present certain morphology or factors. Thus, the information could be reference for clinical specialists to choose appropriate candidates and to explain the outcome after surgery. METHODS: Patients who received LMS from July 2009 to February 2013 were enrolled, but those with malignancy were excluded. Analyzing the percentage and significance of relevant factor such as gender, age, occupation, past illness with medical history, duration of hoarseness, pre-operative clinical diagnosis by fiberscope, length and morphology of pathology, and post operative voice quality. RESULTS: Of 111 patients, middle-aged (40-59y/o) people (50.1%) were the most common population who received LMS, and women were predominant (63.1%). Most female’s occupation was housewife (38.6%), and they were non-smokers (82.9%). On the other hand, most male’s occupation was labor (46.3%), and they were smokers (75.6%) mainly. The distribution of population between male and female was similar in terms of adolescent, adult, middle-aged and elder-aged people. Middle-aged people were the most popular population among total patients, female and male respectively (50.5%; 58.5%; 44.3%), followed by adults (35.1%; 29.2%; 40%). Smoking was the leading risk factor (38.7%). The duration of hoarseness was around half year. The clinical diagnosis were below; polyps, nodules, cysts, mixed-type and leukoplakia, and the most common diagnosis is polyps (46.8%) and the second was nodules (27.9%). However, the pathologic size between polyps and nodules was significant and different (p ＜ 0.001). Some patients (9.7%) remain hoarseness after surgery for 4 weeks, and there were few patients (7.8%) who experienced recurrence of vocal lesion and second surgery were performed. CONCLUSIONS: The causes and will for LMS surgery were quite different between female and male, most females would like to improve quality of voice, especially housewife. Most of men were labor worker, and they needed to of shout, therefore they had to receive surgery. Pathological size was important for clinical diagnosis, and shape and location are also significant. Finally, LMS is an effective and safe surgery to resect bulging vocal lesion and to improve quality of voice.

並列關鍵字

hoarseness ； vocal polyp ； vocal nodule ； laryngomicrosurgery