全喉术后气动式人工喉发音重建的临床应用

摘要： 目的 探讨气动式人工喉的构造、 使用及临床应用， 为全喉切除患者行发音重建提供参考依据。方法 对15例全喉切除的喉癌患者运用自行研制的气动式人工喉行发音重建， 研究其构造、 发音原理及应用效果， 分别采用听距法、 嗓音主观听感知评估方法 （GRBAS量表） 和嗓音障碍指数 （VHI） 量表对发音效果进行评估， 并对患者进行随访。结果 15例患者经训练1周基本能正常交流。发音效果评估： 听距法， 达Ⅰ～Ⅱ级者14例 （93.33%）； GRBAS 量表， 除1例嗓音虚弱程度 （A） 为2分 （中度异常） 外， 15例患者其余指标均为0～1分， 即正常或轻度异常； VHI量表， 14例患者发音训练2周后VHI量表各项得分和总分明显低于发音训练1周后， 差异有统计学意义 （P＜0.01）， 而发音训练1周后功能 （F） 和生理 （P）、 功能 （F） 和情感 （E） 有明显相关性， 2周后三者间没有明显相关性。随访结果显示， 排除肿瘤复发而病故者， 最终流利、 清晰讲话者12例， 成功率为85.7%。结论 气动式人工喉的应用能让无喉患者讲话清楚、 流利， 保持原有的语言特点。该方法操作简便、 成功率高， 短期内训练时间越长发音效果越好， 值得临床推广使用。

Clinical application of pneumatic artificial larynx for voice rehabilitation after total laryngectomyClinical Application of Pneumatic Artificial Larynx for Voice Rehabilitation after Total Laryngectomy

Abstract: Objective To explore the structure, use and clinical application of the pneumatic artificial larynx, and to provide the reference for clinical application for patient’ s better voice rehabilitation. Methods For 15 laryngeal cancer patients underwent total laryngectomy, the pneumatic artificial larynxes developed by ourselves were applied for voice rehabilitation. The structure, pronunciation principle and application effect of the pneumatic artificial larynxes were studied. The hearing distance method, voice subjective auditory-perceptual evaluation method (GRBAS scale) and voice handicap index (VHI) scale were used to assess the pronunciation effect. And the patients were followed up. Results Fifteen cases basically could communicate as normal after training for one week. Evaluation of pronunciation effect: 14 cases (93.33%) reached level Ⅰ to level Ⅱ evaluated by hearing distance method, 15 patients were 0 to 1 points, except for one case with 2 points (with voice weakness A) evaluated by GRBAS scale. The total scores of VHI scale were significantly lower after two- week pronunciation training compared with one-week pronunciation training in 14 patients (P＜0.01). There was a significant correlation between function (F), physiology (P) and emotion (E) after one week pronunciation training. There was no significant correlation between F, P and E after two-week pronunciation training. Follow-up results showed that 12 cases could speak fluently and clearly, reaching the success rate of 85.7% excluding one case died because of tumor recurrence. Conclusion The application of pneumatic artificial larynx can make the patient without larynx to speak clearly and fluently, and maintain the original linguistic features. The method is easy to operate and has high success rate, and the longer training time, the better the pronunciation effect is, which is worthy of clinical promotion for application.