Comparison Of Laryngeal Function And Quality Of Life After SCPL-CHEP And Vertical Partial Laryngectomy

Objective:To compare and analyze the laryngeal function and quality of life after supracricoid partial laryngectomy with cricohyoidoepiglottopexy(SCPL-CHEP)and vertical partial laryngectomy(VPL),analyze and summarize the advantages and disadvantages of the two surgical methods,provide valuable reference for improving surgical techniques and postoperative laryngeal function and quality of life of patients,and explore the feasibility of replacing VPL with SCPL-CHEP.Methods:The patients with glottic laryngeal squamous cell carcinoma who underwent SCPL-CHEP and VPL in our hospital from January 2015 to July 2022 were statistically analyzed.A total of 110 patients were included in the study,of which 45 underwent SCPL-CHEP and 65 underwent VPL.They were divided into CHEP group and VPL group.The respiratory function,voice function,swallowing function and quality of life were evaluated half a year after the operation The extubation rate and tube time of the two groups of patients were compared to compare the respiratory function;the voice acoustic parameters were analyzed by using Praat software after collecting the patients’ audio,recording the patients’ fundamental frequency(F0),fundamental frequency perturbation(Jitter),amplitude perturbation(Shimmer),maximum phonation time(MPT),and combining with the patients’ new glottis morphology,to compare the voice function;by performing modified X-ray swallowing imaging examination(modified barium swallow,MBS),observing the patients’ swallowing of four different types of food(liquid food,semi-liquid food,paste food,solid food),combined with modified penetration-aspiration scale(MPAS)to compare the swallowing function;using the quality of life assessment scale(HNQOL)proposed by the University of Michigan for head and neck surgery patients to evaluate the quality of life.Results:Four patients were lost to follow-up in the CHEP group and seven in the VPL group.A total of 99 patients were followed up,41 in the CHEP group and 58 in the VPL group.1.In terms of respiratory function,the decannulation rate in CHEP group was100%,the median number of days with tubes(P25,P75)was 77.00(66.50,90.00),the decannulation rate in VPL group was 86.2%,and the median number of days with tubes(P25,P75)was 103.50(87.25120.75).There were statistical differences between the two groups in the decannulation rate and days with tubes,and the CHEP group was better than the VPL group.2.In terms of voice function,regarding neoglottis morphology analysis,the two groups of patients had different degrees of neoglottis closure and diverse sources of vibration.The neoglottis morphology of the VPL group was closer to normal physiological state and anatomical structure,with better glottal closure during phonation,while the glottal morphology of the CHEP group was relatively variable and irregular,with significantly worse glottal closure;during phonation,new glottal vibration modes were formed by retained single/double-sided arytenoid mucosa(A)and/or pyriform sinus mucosa(S)and/or epiglottic mucosa(E).Due to gender differences in F0,only male laryngeal cancer patients(40 cases in CHEP group and52 cases in VPL group)were included for voice acoustic parameter analysis by t-test.There were statistical differences between the two groups in F0,Jitter,Shimmer,MPT(P<0.05),among which F0 and MPT were higher in VPL group than in CHEP group,jitter and shimmer were higher in CHEP group than in VPL group,indicating that voice function recovery was better in VPL group than in CHEP group,with better voice quality and phonation function.3.In terms of swallowing function,after MBS examination of the two groups of patients,MPAS scoring was performed.A total of 80 cases of liquid diet were normal:SCPL-CHEP33 cases,VPL 47 cases.A total of 87 cases of semi-liquid diet were normal: SCPL-CHEP37 cases,VPL50 cases.The paste food was normal in 94 cases:SCPL-CHEP39 cases,VPL55 cases.The solid food was normal in 98 cases:SCPL-CHEP40 cases,VPL 58 cases.Non-parametric Mann-Whitney U test rank sum test was used for statistical analysis.There was no statistical difference between the two groups of patients in swallowing liquid food,semi-liquid food,paste and solid food(P>0.05).According to the MPAS scoring results,solid food,paste food,semi-liquid food and liquid food were all scored as one point as the evaluation criterion for normal swallowing function.There were 33 patients(80.48%)with completely normal swallowing function in the SCPL-CHEP group and 47 patients(81.0%)with completely normal swallowing function in the VPL group.The chi-square test was performed on the completely normal swallowing function rate of the two groups of patients.The result showed that chi-square value=0.005,P=0.946>0.05,indicating that there was no statistical difference between the two groups of patients in swallowing function.4.In terms of quality of life,there were statistical differences between CHEP group and VPL group patients in conversational ability,psychological function(disease reason,social interaction,entertainment work),olfactory condition and sputum condition(P<0.05),and CHEP group was better than VPL group;there were statistical differences between speech function(voice volume,voice clarity)and pain sensation(P<0.05),and VPL group was better than SCPL-CHEP group;there were no statistical differences between economic reason and physical function(eating condition)between the two groups(P>0.05).Conclusions:1.In terms of respiratory function,the extubation rate of SCPL-CHEP patients after operation is higher than that of VPL,and the intubation time is shorter than that of VPL,indicating that the respiratory function of SCPL-CHEP patients after operation is better than that of VPL;2.In terms of voice function,the F0 and MPT of VPL patients after operation were higher than CHEP,and the jitter and shimmer were lower than CHEP,indicating that the voice quality and voice function of VPL patients were better than CHEP;3.In terms of swallowing function,there was no statistical difference between SCPL-CHEP and VPL patients in swallowing food of different characteristics and the normal rate of swallowing function,which showed that the swallowing function of the two types of operation was not good or bad;4.There was no statistical difference in the quality of life between SCPL-CHEP and VPL patients in terms of physical function.VPL patients were better in terms of speech function,and SCPL-CHEP patients were better in terms of social function.