Mikrolaryngoskopie: Eine populationsbezogene Analyse zu Outcome, Komplikationen und Operationsraten

Zusammenfassung

Hintergrund

Obwohl die Mikrolaryngoskopie (MLS) ein integraler Bestandteil der operative HNO-Heilkunde ist, gibt es keine populationsbezogenen Untersuchungen zu den Operationsraten und der Effektivität der MLS in der klinischen Routine.

Methoden

Alle 616 Patienten, die 2011 in einer der 8 Thüringer HNO-Kliniken eine MLS erhielten, wurden hinsichtlich Patientencharakteristika, Therapie, Komplikationen und Nachuntersuchung analysiert.

Ergebnisse

Die stationäre Aufnahme erfolge vorrangig wegen einer gutartigen Erkrankung des Larynx (60%) und bei 33% wegen eines Malignoms oder Verdacht auf ein Malignom. Bei Verdacht auf einen gutartigen Prozess wurde dies in 98% der Fälle bestätigt. Der Verdacht auf einen bösartigen Tumor bestätigte die MLS in 51% der Fälle bzw. wurde in 49% ausgeschlossen. Ein transientes Larynxödem (22%) und revisionspflichtige Blutung (1%) waren die häufigsten Komplikationen. Ein Zahnschaden trat in 2 Fällen auf (0,2%). Ein Rezidiv der ursprünglichen Erkrankung wurde in 14% beobachtet. Eine längere Operationszeit war ein unabhängiger Prädiktor für eine postoperative Blutung (p=0,05) oder ein Larynxödem (p=0,013). Eine Re-MLS (p<0,0001) und die endgültige Diagnose eines bösartigen Tumors (p=0,017) waren unabhängige Prädiktoren für ein Rezidiv. Die Operationsrate lag bei 22,98/100000 Einwohner. Die höchste Inzidenz lag beim Patientenalter von 50–59 Jahren mit 39,76/100000. Gutartige Tumoren waren die häufigste Indikation mit einer Rate von 19,33/100000.

Diskussion

Diese populationsbezogene Analyse zeigt dass die MLS eine effektive chirurgische Maßnahme mit geringen Risiken im Alltag des HNO-Arztes ist.

Abstract

Background

Although microlaryngoscopy is an integral part of surgical routine of otorhinolaryngologists, there is no population-based data published on surgery rates and efficiency of microlaryngoscopy country-wide or nation-wide.

Methods

All 616 patients who underwent microlaryngoscopy 2011 in one of the eight ENT departments in Thuringia were analyzed according to patients’ characteristics, therapy, complications and follow-up.

Results

The majority of admissions were performed because of a benign disease (60%) of the larynx, and in 33% related to a malignant disease or suspicion of a malignant disease. When a benign disease was suspected, it was confirmed 98% of cases. When a malignant tumor was suspected, it was confirmed in 51% of cases, i. e. ruled out in 49% of cases. Transient laryngeal edema (22%) and bleeding needing revision surgery (1%) were the most frequent or serve observed postoperative sequelae. Teeth damage occurred only in 2 cases (0.2%). A recurrence of the primary disease was observed in 14%. Longer surgery time was an independent predictor for postoperative bleeding and for postoperative laryngeal edema (p=0.050 and p=0.013, respectively). Revision surgery (p<0.0001) and a final diagnosis of a malignant disease (p=0.017) were independent predictors for recurrence of the primary disease. The overall incidence of microlaryngoscopy was 22.98/100000 population. The highest incidence was seen for patients 50–59 years of age with 39.76/100000. Benign diseases were the most frequent indication with 19.33/100000.

Discussion

This population-based analysis is showing that microlaryngoscopy is performed effectively and with low postoperative risks in daily routine of otorhinolaryngologists.

Schlüsselwörter

Larynx - Chirurgie - Larynxmalignom - gutartiger Tumor - Outcome - Epidemiologie - Versorgungsforschung - direkte Laryngoskopie

Key words

larynx - surgery - laryngeal cancer - benign tumor - outcome - epidemiology - health services research - direct laryngoscopy

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