Alternative TitleThe Outcome of Voice Restoration with Provox^<【○!R】> after Total Laryngectomy
Note (General)2008年6月～2019年5月に施行したProvox^<【○!R】>留置術53例を後ろ向きに検討した．音声再獲得率，入院加療を要した合併症の発生率，音声再獲得および合併症発生に関連する因子を統計学的に解析した．年齢中央値は68歳，性別は男性50例(94.3%)，女性3例(5.7%)であった．放射線治療の「既往あり」27例(50.9%)，「既往なし」26例(49.1%)，留置方法は一期的留置11例(20.8%)，二期的留置42例(79.2%)であった．ST介入「あり」33例(62.3%)，「なし」20例(37.7%)であった．Performance Status Scale for Head and Neck Cancer(PSS-HN)に基づくPSS-HN=75以上の音声獲得率は47例(88.7%)であった．ST介入あり群(96.7%)は，なし群(76.2%)に比して音声獲得率は有意に高かった(p=0.0307)．入院を要する合併症は13例(24.5%)に生じた．放射線治療の有無や留置術のタイミングによる合併症発生率に差はなかった．Provox^<【○!R】>による音声再獲得率は，特にST介入症例で有意に向上していた．リハビリテーションの効果に加えて，患者側のコミュニケーション意欲が向上したことも要因である．今後はProvox^<【○!R】>管理が可能な施設の増加，他施設・他診療科医師への啓発が課題と考えられた．
The voice prosthesis, provox^<【○!R】>, is widely used for voice restoration after total laryngectomy. We conducted a retrospective review of the medical records of 53 head and neck cancer patients who received provox^<【○!R】> placement between June 2008 and May 2019. The voice restoration rate and incidence of complications were analyzed. Factors associated with successful voice restoration and development of complications were also examined. The median age of the patients was 68 years ; 50(94.3%) were male and 3(5.7%) were female ; 27 patients (50.9%) received prior radiotherapy ; 11 patients underwent primary provox^<【○!R】> placement, at the same time as the laryngectomy, while 42 patients (79.2%) received secondary placement, at a later time after laryngectomy. Overall, 33 patients received intervention by a speech-language therapist(ST) (62.3%). According to the Performance Status Scale for Head and Neck Cancer(PSS-HN), successful voice restoration was achieved in 47 patients (88.7%). The voice restoration rate was significantly higher in the patient group that received intervention by a ST (96.7%) as compared to that in the patient group that did not receive ST intervention (76.2%)(p=0.0307). Thirteen patients (24.5%) needed re-hospitalization for complications related to provox^<【○!R】>. Neither irradiation nor the timing of provox^<【○!R】> placement (primary or secondary) affected the complication rate. The rate of voice restoration with provox^<【○!R】> placement after laryngectomy was favorable, and ST intervention significantly improved the rate of voice restoration. Complications requiring hospitalization (24.5%) were comparable to previous reports. Increasing the number of facilities that can manage the complications and educating other medical institutions, physicians, and professionals about provox^<【○!R】> are some important issues that need to be addressed in the future.
日本耳鼻咽喉科学会会報. 2021, 124(2), 128-134.
新大博(医)第1819号
Collection (particular)国立国会図書館デジタルコレクション > デジタル化資料 > 博士論文
Date Accepted (W3CDTF)2022-05-09T11:57:37+09:00
Data Provider (Database)国立国会図書館 : 国立国会図書館デジタルコレクション