低阻力型Groningen硅胶发音钮喉全切除术后发声重建

目的评价低阻力型Groningen硅胶发音钮喉全切除术后发音效果及使用寿命.方法随机选择7例喉癌行喉全切除术的患者,术中一期安装发音钮;3例喉全切除后未做任何发声重建术的无喉患者,行二期安装发音钮.术后按照Parker制订的方案进行发音效果评估,并随访其使用情况.结果 10例患者术后均能较好的讲话,平均综合得分4.6分（3.3～6.9分）,高于安装其他类型发音钮患者的得分,有效使用期均超过6个月.结论低阻力型Groningen硅胶发音钮具有配套的安装和更换器械,手术简单,术后发音效果好,使用寿命长,适合在我国推广使用.     

喉全切除术后安装发音假体失败原因分析

目的 探讨喉全切除术后患者Ⅱ期行气管食管穿刺造瘘安装发音假体行发音重建后发音失败的原因,并找出有效的解决措施.方法 34例喉癌、下咽癌患者.喉全切除术后6个月,安装发音假体7天后不能发气管食管音,观察其发音不成功的原因并作相应处理.结果 34例发音失败者中,14例是因为环咽肌或咽下缩肌痉挛所致,切断咽缩肌或行咽缩肌神经丛切除术后.12例发音成功;11例因发音假体大小不合适,更换合适的发音假体后,10例发音良好;9例因造瘘口感染、瓣膜粘连闭合等,经对症处理后均能发出气管食管音.发音不成功的原因可概括为:①咽周嗣肌肉痉挛;②白色念珠菌沉积于瓣膜上或造瘘口感染;③发音假体大小不合适,太长或太短;④发音假体瓣膜变质、粘连闭合等.结论 喉全切除术后安装发音假体失败的主要原因是并发症,可行选择性咽缩肌切断术或咽丛神经切断术、更换发音假体、抗炎治疗等,经过训练,可获得气管食管音.     

全喉切除术后改良一期发音钮重建发音术的临床研究

目的 探讨全喉切除术后不预置扩张管,一期置入发音钮的技术。方法 回顾我院1999年1月-2002年5月行全喉切除术病人158例,其中71例(A组)采用先放置气管-食管扩张管,形成气管-食管瘘后再安置发音钮的方法;87例(B组)采用直接置入发音钮的发音重建的方法。结果A、B两组的发音成功率分别为95.8%和97.7%,两组比较无统计学意义(P>0.05)。结论本术式只需一次手术即可全部完成,减少了对病人的侵入性损伤,同时简便、易行、节约费用,更易被病人接受。     

两步发音训练法在喉全切除Groningen发音钮置放术的应用体会

目的 总结喉全切除患者,应用Groningen发音钮,通过两步发音训练法进行发音训练的体会.方法 本组32例患者,男25例,女7例,年龄46～78岁,平均64.5岁,一期置放发音钮30例,二期置放2例,后者均为男性,上述患者均接受喉全切除手术治疗,术后随诊均为1年以上.结果 能进行言语交流31例,其中优秀者可以连续数35个数,并能进行电话交流,发音失败1例,患者为发音钮脱落.结论 喉全切除放置低阻力Groningen发音钮是喉全切除术后恢复发音功能的一种简便、效果可靠的方法.     

喉全切除术后Blom-Singer发音管的临床应用

目的：分析Blom-Singer发音管在喉全切除术患者中的应用效果。方法：1995－1999年期间为18例因喉癌行喉全切除的患者安装了气管食管发音管，12例行一期发声重建术，6例行二期发声重建术，全部采用Blom-Singer发音管，结果：本组病例均随访3－5年，无死亡，本组成功者14例，成功率为77．8％，带管时间8－19月不等，平均为12月，换管次数最多的为6次。无严重并发症，失败者均为二期手术者，结论：凡喉全切除术者均可行一期发声重建术，二期手术的适应症必须严格控制，应重视术后发声训练，对于食管发声无效的喉全切除患者，气管食管发声重建术是一种有效的补充方法，能提高生活质量。     

改良Amatsu法全喉切除术后的发音重建

目的：对全喉切除术后Ⅰ期气管食管造瘘术式发音重建进行临床评价。方法：用改良Ａｍｓｔｓｕ法对２０例患者实施全喉切除术后Ⅰ期发音重建术。结果：２０例全喉切除术后发音重建术患者随访１￣８年,最终有１６例获得发音功能。结论：全喉切除术后一期完成气管－食管造瘘发音重建术,适用于所有的全喉切除术或同期作根治性颈廓清术及术后放疗的患者,能较好地解决全喉切除术后发音问题。     

喉全切发音钮安装术中环咽肌切开的临床价值

报告喉全切发音钮安装术中，同时行环咽肌切断２４例，与３９例未切断组比较，前者无一例发生术后痉挛性发音障碍，后者发生率为７．６９％（３／３９）；两组咽瘘发生及鼻饲天数相似，统计学无显著性差异（Ｐ＞０．０５）。表明术中切断环咽肌是预防发音钮术后痉挛性发音障碍的一种简便而有效的方法。     

喉全切除术后发音重建术

喉全切除术是治疗晚期喉癌的主要方法,手术后发音问题是患者关注的重点之一。喉全切除后患者丧失发音功能,不能与他人正常进行语言交流,破坏患者的社会交往能力,在精神上产生很大的压力,严重影响了术后生活质量,尤其是不认字的老年患者,他们即不能用语言表达,也不会写文字交流,     

A new prosthesis for voice rehabilitation after laryngectomy

Summary Since the first laryngectomy, several surgical and prosthetic techniques have been developed in order to restore voice. Problems encountered with these techniques include: Leakage through the tracheoesophageal fistula, spontaneous closure of the fistula, dislodgement of the prosthesis, and the use of adhesives for fixation. We now introduce a new silicone voice prosthesis that overcomes these problems. The prosthesis is easily inserted as a one-stage procedure during total laryngectomy. Successful acquisition of voice was achieved in 30 of 33 patients, irrespective of preoperative or postoperative radiotherapy. Average device life proved to be approximately 100 days. The high rate of success with minimal morbidity merits further investigation of this one-stage voice rehabilitation technique.     

选择性咽缩肌切断术在全喉切除术后发音重建中的作用

对１０例喉癌患者行全喉切除术后Ⅱ期Ｂｌｏｍ－Ｓｉｎｇｅｒ发音重建，并行选择在咽缩肌切断术，术后８例发音重建成功，并对咽缩肌切断术的作用及要点加以讨论。     

Speech restoration with tracheoesophageal prosthesis after total laryngectomy: An observational study of vocal results,complications and quality of life

ObjectivesTo study voice prosthesis survival, complications, efficacy and impact on quality of life.MethodsA single-center observational study was performed in patients treated for squamous cell carcinoma of the larynx or hypopharynx by total (pharyngo)-laryngectomy between 2010 and 2015. Study data comprised: maximum phonation time (sec), number of and reasons for prosthesis exchanges (leakage through or around the prosthesis, expulsion or inclusion of the prosthesis), plus 2 quality of life questionnaires (QLQ-C30, QLQ-H&N35) and the Voice Handicap Inventory (VHI 30).ResultsForty-nine patients were included. The most common causes of prosthesis exchange were leakage through (73.2%) or around the prosthesis (18.5%). The median time between exchanges was 4 months. Global quality of life status on the QLQ-C30 was 63.5. Mean maximum phonation time was 7.4 sec. Mean VHI was 46/120; 10 patients had a mild voice handicap, 12 moderate and 10 severe. No relation emerged between the number of prosthesis exchanges per year and quality of life. Voice handicap significantly decreased quality of life, with QLQ-C30 72.3 for the 22 patients with mild to moderate voice handicap and 44.2 for the 10 patients with severe voice handicap (P = 0.001).ConclusionVoice restoration by tracheoesophageal prosthesis after total (pharyngo)-laryngectomy is a reliable technique that decreases voice handicap and, despite potentially serious complications, has little negative impact on quality of life.     

Voice rehabilitation with Provox2 voice prosthesis following total laryngectomy for laryngeal and hypopharyngeal carcinoma

OBJECTIVE: To analyze the effectiveness of the Provox2 voice prosthesis for voice rehabilitation following total laryngectomy. METHODS: From September 2000 to December 2004, the Provox2 voice prosthesis was used for voice rehabilitation in 32 patients following total laryngectomy. The quality of speech with the Provox2 voice prosthesis was analyzed using the HRS rating scale, the maximum phonation time (MPT), incidence of complications and the in situ lifetime. The rate of speech restoration was further analyzed in 129 patients with total laryngectomy from 1996 to 2004. RESULT: Twenty-nine of 32 patients were able to restore speech using the Provox2 voice prosthesis, a speech restoration rate of 90.6%. The maximum phonation time (MPT) was measured in 18 patients using the Provox2 voice prosthesis. The mean MPT was 15.1 s, with a range of 8-28 s. MPT was not influenced by age, concurrent radiotherapy treatment, the location of the primary tumor or use of reconstructive surgery. The average lifetime of the Provox2 in patients with laryngeal carcinoma (12 patients) and hypopharyngeal carcinoma (17 patients) was 27.2 and 16.6 weeks, respectively, which was significantly different (P=0.024, non-parametric Mann-Whitney's U-test). The rate of speech restoration by the use of esophageal speech, and insertion of an artificial larynx was 62.7% for laryngeal carcinoma (59 cases) and 38.6% for hypopharyngeal carcinoma (70 cases), which was also significantly different (P<0.01, chi-square test). CONCLUSION: Provox2 voice prosthesis speech was very useful due to the higher rate of speech restoration, longer phonatory time, and better intelligibility. It was also thought that voice prosthesis speech was useful in conjunction with esophageal speech and an artificial larynx depending on the patient's condition or wishes.     

Aerodynamic characteristics of the Provox low-resistance indwelling voice prosthesis

Summary The use of various prostheses for voice rehabilitation after total laryngectomy has become widely accepted in recent years. Two different types of prostheses can be distinguished: non-indwelling devices, which can be removed and replaced by the patient, and indwelling voice prostheses, which have to be removed and replaced by a physician. In this report we describe the in vitro measurement of the airflow dynamics of the recently developed Provox low-resistance, indwelling voice prosthesis. Airflows used in these experiments varied from 0.05 to 0.4 1s^–1. With increasing flows, the transdevice air pressure against airflow rates increased from 0.28 kPa to 1.36 kPa, while the mean airflow resistance decreased from 5.6 to 3.4 kPa 1^–1 s^–1. From these data and by comparison with data for other prostheses, the Provox voice prosthesis shows favorable airflow characteristics.     

喉全切除发声重建术后发声功能评估

目的 :对喉全切除气管断端膜样部食管吻合分流发声重建术后气管食管 (TE)音患者的发声功能进行客观评估。方法 :对TE音组、食管音组及健康组进行发声声学分析及最大发声时间比较。测定了 2 0例TE音患者舒适发声时的气管内压。在电子喉镜下观察TE音和食管音患者发声时咽食管段黏膜的振动情况及“新声门”的形态。结果 :TE音与食管音相比各发声声学参数差异均无统计学意义 ,而与健康组相比 ,除基频、振幅外 ,基频微扰、振幅微扰、谐噪比和标准化噪声能量等参数均有统计学意义。TE音患者舒适发声时的气管内压为(2 .86± 0 .6 9)kPa。两组无喉音发声时的咽食管段黏膜大多振动规律 ,新声门形状多为环状。结论 :TE音组的发声声学特征同食管音组相近 ,与健康组相比均有显著差异 ,但TE音的音调更接近健康组。本发声重建术后患者发声省力。     

Vocal rehabilitation after total laryngectomy using the Provox voice prosthesis

Vocal rehabilitation in laryngectomized patients can be attained by surgical (tracheoesophageal speech) or conservative methods (oesophageal speech or artificial larynx). We prospectively studied voice restoration in 37 patients who underwent total laryngectomy in the period from February 1991 to February 1993. The patients were given the opportunity to assess both non-shunt oesophageal speech and shunt oesophageal speech using the Provox voice prosthesis. The Provox low resistance, self-retaining voice prosthesis is a biflanged device made of silicon rubber. A primary tracheoesophageal puncture was made in 28 patients, while a secondary puncture was performed in another nine patients. The results were assessed according to criteria established at the ‘Third International Congress on Voice Prosthesis’ in Groningen (1988). Functional tracheoesophageal speech after primary puncture was achieved in 95% of patients 12 months after puncture, while oesophageal voice was acquired by 55%. Only minor surgical and prosthesis-related complications were encountered during this follow-up period in 29% of the patients. The device lifetime varied from 3 months to at least 2 years (mean 5.4 months).     

Myomucosal shunt following total laryngectomy: a report of 31 cases

Summary An original technique of voice rehabilitation following total laryngectomy based on the concept of a myomucosal unit was originally described by Strome. Thirty-one cases of myomucosal shunts (MMS) are analyzed in the present report. The 14 initial cases failed because of a lack clinical and surgical experience and insufficient selection of the patients. Among the last 17 cases, 1 was lost to follow-up, 1 had an insufficient follow-up, and 2 patients refused to speak with the MMS instead of a patent shunt; 5 of the remaining patients had voices evaluated as excellent, 7 had voices interpreted as good and only 1 patient had a voice evaluated as poor. Aspiration was not a problem. Eleven patients were found to stenose their shunt, but fistula were recalibrated successfully. The MMs can be used safely in oncological surgery and only 1 of 31 deaths in our total experience was due to a local recurrence. These findings show that the MMS is a reliable procedure for voice restoration following total laryngectomy; a prosthesis is not required and there are currently no oncological limits to the procedure. However, a very close follow-up of the patients is required after surgery.Presented at the first European Congress of Oto-Rhino-Laryngology and Cervico-Facial Surgery, Paris, 26–29 September 1988     

In-clinic secondary tracheoesophageal puncture and voice prosthesis placement in laryngectomees

Secondary tracheoesophageal puncture (TEP) with voice prosthesis placement represents one of the possibility to restore vocal function after total laryngectomy. However, some patients have comorbidities that contraindicate general anesthesia. In our department, an in-clinic TEP procedure for retrograde voice prosthesis placement was developed. It allows the immediate placement of the prosthesis and the avoidance of the use of dilators. We described our technique with advantages and pitfalls. The Provox Vega Puncture Set was used. Our technique for in-clinic secondary TEP without general anesthesia or target controlled infusion was a safe and effective procedure. It allows the use of the traditional TEP set, with possibility of voice prosthesis placement after previous TEP closure.     

Evaluation of voice and speech following subtotal reconstructive laryngectomy

Subtotal reconstructive laryngectomy (SRL) can be used to preserve voice in the treatment of selected laryngeal carcinomas. This study was designed to analyze both voice and speech results achieved after SRL in 14 male patients, aged from 48 to 73 years. Surgery was performed between 1983 and 1993. Fundamental frequencies, ranges of frequency, intensities, and intensity ranges were established using an S.I. 80 Philips AAC 600 Audio Active Comparative Language System. Five prolonged vowels and six phonetically balanced sentences were recorded on a tape positioned at a distance of 30 cm from the mouth of each patient during a 3-min recording time. The recorded material was then evaluated by a panel of ten trained listeners who were asked to consider the qualitative parameters and perceptual characteristics of voice and speech according to a scorecard modified from one devised by Voiers and Formigoni. Although a decrease was determined in Fundamental Frequency and intensity of the voice when compared to normal values, the quality and perception of speech were found to be satisfactory. The verbal message could be understood almost exactly by means of constant sonority, correct articulation and improved pneumophonic coordination. These values demonstrate that the new voice achieved after SRL is less sonorous and allows for understandable and socially acceptable speech. Received: 10 April 1996 / Accepted: 19 September 1997