The Objective Evaluation Of Preoperative And Postoperative Laryngeal Function For T1Glottic Cancer

Objective:Laryngeal cancer is one of the most common malignant tumor in head and neck, surgery is the main treatment. With the improvement of living standards, the requirements for people’s life quality improved gradually. It is the development tendency of modern laryngeal surgery that both resecting the tumor completely and retaining laryngeal functions as far as possible,which is also a focus research of laryngeal surgery at present. At the moment, the indicators for the evaluation of laryngeal functions after laryngoplasty, are in the light of the decannulation rate of respiratory function and on pronunciation function of subjective ratings at home and abroad. There are lack of systematic, objective evaluation criteria. In this study, the spiral CT simulation endoscopic imaging, electronic laryngoscope, and objective examination method such as voice spectrum analysis are used to observethe change of laryngeal structure, pronunciation and respiratory function before and after operation forTl glottic cancer., We hope to establish objective examination indicators which is to mend further promote throat forming operation, and to improve the patient’s quality of life and the pronunciation.Method:25male patients of T1glottic cancer were accepted partial laryngectomy. Before the operation, all the patients was objectively checked by multilayer helical CT enhancement scanning and virtual endoscopy, which was to measure the largest open area preoperative glottis and the distance between the vocal process, recorded by EndoSTROB ent multi-functional diagnostic operation system from Xion company in Germany.3months later, the postoperative laryngeal changes of morphology and phonic function were recorded once again. The biggest open area and posterior glottis maximum transverse diameter of the postoperative glottis were measured, including postoperative voice changes. Praat software analysis system was used to make the standard voice acoustic test respectively to the patents of T1glottic cancer,Jitter, Shimmer, NNE, HNR included. SPSS17.0statistical software was used tocompare the glottis area to the influence on voice.Results:1. It decreases obviously not merely the glottis area but also the maximum posterior glottis transverse diameter. There are significant difference in the decrease of statistical significance between the preoperation and postoperation.T values were12.365,14.173respectively, P values were0.000<0.05.2. Bymaking voice acoustic analysis before and after surgery.the results showed that there was no statistically significant difference in Jitter, Shimmer and HNR, the t values were1.731,0.200,2.621respectively, P values were0.096,0.843,0.081respectively all>0.05,but there was statistically significant difference in NNE, the t value was10.502, P value was0.000<0.05.3.After the partial laryngectomy with T1glottic cancer, it has linear correlation between the biggest glottis open area with posterior maximum glottis transverse diameter. The regression coefficient R is0.689, P value was0.000<0.05, there is statistical significance.4.There is a statistical regression analysis between the biggest glottis open area with posterior maximum glottis transverse diameter postoperation. The equation is S open area glottis0.0618+12.363dmaximum transverse diameter at the back of the glottis.5.It indicated by this study, it is likely to both remove trachea cannula and achieve better postoperative voice when posterior maximum glottis transverse diameter is between4.7and12.7mm..Conclusion:Helical CT virtual endoscopy can highly describe the real vivisection structure by using its own measurement system to measure the glottis area, which is provide an easy way for accurate measurement of the glottis data. This study quantify both the required minium glottis area after removing the trachea cannula postoperativelyfor the T1glottis cancer and the maximum glottis open area that maintain better pronunciation. The postoperative laryngeal function who accept the surgical treatment can be evaluated more accurately and objectively by combining the glottis measurement data with voice acoustic test data.