全喉切除Ⅰ期气管食管造瘘发音重建术

目的:探讨全喉切除病人发音方法.方法:对34例全喉切除术后I期行气管食管造瘘安装解放军201医院耳鼻喉科研制的发音钮.结果:效果满意,患者均能清晰发音,语言流利,地方语言特色明显,配戴发音钮最长观察已满6年(有效使用期2年,最多已更换3次发音钮),观察发音有效率100%,误咽率0.结论: 该发音钮有安装、更换方便、使用时间长等优点.为无喉者发音提供了效果满意的方法.     

食管发声法是怎么回事

语言功能的重建,方法很多,目前常见的有外科手术安装发音钮、人工喉的使用和电子喉的应用等.但因这些方法都有一定的局限性,比如价格昂贵、外观不雅等缺陷,难于被大部分病人接受.目前,在世界各国无喉者中,最受欢迎的方法是食管发声法,它具有简单、方便、逼真、安全的特点,又不需要特殊的工具,成为全喉切除后病人语言康复的首选方法.     

喉癌全喉切除加气管—食管瘘喉成形术的研究(附26例报告)

全喉切除术是目前治疗喉癌的主要手段之一,但术后语言能力丧失,为了解决发音问题,各国学者对术式作了广泛的研究并制造了许多发音仪器,但效果仍不满意。自1980年4月至1981年8月我们采用了全喉切除加气管—食管瘘的喉成形术共26例,效果较好,现报告如下。     

全喉切除一期发音重建术

目的：总结对晚期喉癌患者施行全喉切除术后,一期完成发音重建术的方法、要点及效果。方法：对11例晚期喉癌患者施全喉切除,同时切除双侧咽缩肌、进行气管-食管造瘘,一期完成发音重建术,结果：11例患者术后均能正常进食,经安放硅胶发音钮后,均成功发音,随访三个月,其中9例言语自如,音量及音质均佳。2例话音连续性差、音量较低。结论：在全喉切除术中切断咽缩肌同时进行食管-气管造瘘可提高发音重建术的成功率。     

喉全切除后发音重建术(附13例报告)

 某些喉癌病人不能采用喉部分切除术而行喉全切除术，术后丧失发音功能，虽可使用人工喉或食管发音训练而获得一定的发音，但其音质不够理想。近20余年学者们不断研究喉全切除后发音重建术。自Sei afini(1970)于人身上行气管咽部吻合术成功后，喉全切除后发音重建术有了广阔的途径。Arsjan在1972年总结35例保留会厌的喉全切除后气管咽部吻合术，在发音、呼吸和吞咽功能等方面获得较好效果。     

喉癌术后如何进行发声功能锻炼?

语言是通过大脑活动、呼吸、发音和关节活动的过程,鼻、口、咽影响发音的结果。喉切除患者最常用的语言康复是食管语言,患者利用自身的食管发声,不靠任何器械,又避免了手术,经济简便。全喉切除     

舌根成形与舌根下移在喉癌手术中的应用

背景与目的：喉癌尤其是声门上癌手术往往涉及对舌根的处理,以往对累及舌根的晚期喉癌行舌根大部切除后,缺乏简单有效的舌根修复方法,因而许多患者的喉功能恢复不理想。此外,以舌根瓣来重建喉功能以往报道亦较少。本文探讨喉癌手术治疗中对舌根的处理方法,以期提供一种简便可靠的喉功能重建的术式。方法：切除喉部肿瘤或被累及的舌根后,根据组织缺损的情况,以胸骨舌骨肌筋膜瓣成形舌根;舌根保留较多时以舌根下移来重建喉功能。结果：32例喉部分切除术中,26例拔管,拔管率为81．3％,患者均恢复满意的发音功能;4例全喉切除术未行发音重建。无误咽、呛咳发生。3年生存率为81．3％,5年生存率为65．6％。结论：舌根成形与舌根下移能恢复满意的喉功能,操作简单、创伤较小、并发症少,是喉癌治疗中较为理想的手术方式。     

扩大部分喉切除颈前肌皮瓣喉重建术临床观察

目的　探讨颈阔肌双蒂转门肌皮瓣在喉重建术中的临床应用价值。方法　对 38例喉癌行扩大部分喉切除术 ,包括扩大垂直喉切除术 2 7例 ,扩大额侧喉切除术 7例 ,次全喉切除术 4例 ,应用颈阔肌双蒂转门肌皮瓣同期进行缺损喉腔重建 ,结果　本组病例术后气管套管拔除率为 92 1% ( 35 /38) ,全部患者恢复了发音功能 ,语言响亮清晰者 95 0 % ( 36/38) ,吞咽防护功能全部恢复 ,局部复发率 7 9% ( 3/38) ,3年生存率 89 5 % ( 3/38)。结论　中晚期喉癌选择性地施行功能保全性喉手术是可行的 ,应用转门肌皮瓣进行缺损喉腔重建可获得满意的喉功能恢复效果     

喉近全切除术治疗晚期唯癌,下咽癌疗效分析

目的：探讨晚期喉癌、下咽癌保留喉功能的方法，降低全喉切除率。方法：对喉癌Ｔ３、Ｔ４病变和下咽癌Ｔ３病变行喉近全切除术１５例。其中喉癌１３例，梨状窝癌２例。年龄４１￣７６岁，平均５６．３岁。临床分期：Ⅲ期９例，Ⅳ期６例。结果：除１例不能发音外，其余１４例（９３．３％）获得了较好的发音和无呛咳吞咽功能。２年生存率７５．０％（９／１２）。结论：该方法在保存发声功能，降低全喉切除率方面有积极作用。     

无喉患者食管发音训练和体会

无喉患者食管发音训练和体会中国医学科学院肿瘤医院头颈外科张玉芳，吕春梅，贺永东我院自１９９０年开始举办无喉患者语言训练班，至今已训练七期，取得一些成功的经验．简介如下：资料与方法患者来自我院术后病人，个别外院手术后病人共７３名，男６２名，女１１名。年...     

喉全切除功能性气管食管瘘发音重建术5例

目的探讨喉全切除功能性气管食管瘘发音重建术的方法，发音效果，适应症和禁忌症。方法选择病例行李树玲式喉全切除功能性气管食管瘘发音重建术5例，手术操作时增加环咽肌切开及放置支撑管两个步骤，术后对发音效果按言语可接受度和言语可懂度进行评价。结果除1例术后第15天出现误吸，缝闭瘘口外，余4例均手术后3周左右行气管食管音的言语评价，3例属优，1例属一般，2月后复查时重新评价属良。结论李树玲术式发音效果好，成功率高，手术一期完成，不给患者增加负担和痛苦，手术操作简单，不需附加装置，创伤小，误咽发生率低。李树玲式功能性气管食管瘘发音重建术是较理想的方法之一。手术时切断环咽肌可避免术后环咽肌痉挛有利于发音。在瘘口放置支撑管可以防止瘘口周围肉芽粘连致瘘口变窄或封闭。     

A Novel Obturator Device for Management of Dilated Trachea-esophageal Puncture Tract Fistulas

Voice rehabilitation in laryngectomized patients by tracheoesophageal puncture is a time tested technique. In some patients the tracheoesophageal puncture gets inordinately dilated leading to leakage around the prosthesis. Most of these fistulas are managed by a variety of conservative treatments like temporary removal of prosthesis, placement of silastic ring over the prosthesis, placement of nasogastric tube and airway protection by a cuffed tracheostomy tube. Intractable fistulas are tackled by surgical closure but are fraught with failures. We hereby suggest a novel temporary obturator that can be can be easily made at a very low cost in any hospital having prosthetic rehabilitation services and obviates the need for a tracheostomy tube, nasogastric tube and repeated hospital visits.     

Olfaction and gustation abilities after a total laryngectomy

Background

A laryngectomy affects many of a patient’s functions. Besides speech and respiratory-tract problems, olfaction and gustation problems can also have an influence on the quality of life. The aim of this study was to find out how often various nasal problems and decreased gustation appear after a laryngectomy.

Patients and methods.

One hundred and five laryngectomized patients (9 women, 96 men, aged 45–88 years), treated in two tertiary centers, were included in the study. They completed a questionnaire about various nasal problems, olfactory and gustatory capabilities, possible allergies and irritants in their environment, and the impact of the nasal and gustation problems on their quality of life.

Results

Olfaction was impaired in 51.4%, and was even not possible in 30.5%, of patients. Decreased gustation abilities were reported in 26.7%, and dysgeusia in 11.4%, of patients. Almost 21% of patients were bothered by an impaired gustatory ability and 50.5% of patients were affected by their loss of olfaction. Frequent nasal discharge was reported in 20%, frequent sneezing in 58.1%, and nasal itching in 33.3% of the laryngectomized patients. There were no correlations between the age and the olfaction and gustation abilities and between the allergy and the nasal symptoms, whereas the correlation between olfaction and gustation appeared significant (p=0.025).

Conclusions

Various nasal and gustatory problems were reported in more than 80% of laryngectomized patients. The olfaction and gustation abilities are connected and have a substantial impact on the quality of life. Like in the case of speech, the rehabilitation of olfaction is also necessary in all laryngectomized patients and must take place soon after the completion of the treatment.     

A brief review of voice restoration following total laryngectomy

Despite advances in conservative laryngeal surgery and radiotherapy, total laryngectomy still remains the procedure of choice for advanced-stage (UICC T3 and T4) laryngeal carcinoma, around the world. The functional rehabilitation of the laryngectomized patients has been a concern of head and neck surgeons and speech therapists. Significant developments in speech rehabilitation over the past three decades have led to substantial improvements in the quality of life of these patients. The tracheoesophageal (TE) voice prosthesis has become the gold standard in various centers for voice rehabilitation since its introduction in 1980. Successful tracheoesophageal voice restoration in laryngectomy patients can be very rewarding and patients no longer have to live in silence while they await the results of their cancer treatments. They can face the challenges of life with the knowledge that a near normal quality of life is very much possible.In this article, we present a brief review of voice restoration following laryngectomy.     

规范化疼痛管理在上腹部术后患者应用中的效果评价

目的：评价规范化疼痛管理在上腹部术后患者临床应用中的效果。方法：将160例患者随机分为对照组和观察组,对照组采用传统的术后疼痛干预,观察组实施规范化疼痛管理,比较对两组患者手术镇痛认知度的影响、术后3d疼痛控制效果、术后生理功能恢复方面的指标。结果：观察组对疼痛知识的认知程度明显高于对照组,术后3d疼痛分值明显低于对照组,睡眠时间多于对照组,肛门排气时间、下床活动时间、住院时间及并发症发生率均明显少于对照组,两组比较差异均有统计学意义（P〈0.05）。结论：规范化疼痛管理改变了患者错误的疼痛认知,有效提高开腹术后的镇痛效果,促进患者康复。     

Surgical voice restoration in alaryngeal patients

Blom Singer’s technique of surgical voice restoration in laryngectomized patient is a highly successful method of speech rehabilitation. This technique has been further simplified and adopted in 20 of our cases with 90% success in acquiring speech. Though primary tracheo-oesophageal puncture (TEP) is a good attempt of rehabilitation, we feel that post-operative healing and fibrosis will displace the puncture site causing difficulty to insert the prosthesis by the patient. The high success rate with secondary TEP makes us believe that it is a better technique to be adopted. Further, plan for secondary TEP will give enough time to the patients to develop oesophageal speech, if they are capable of.     

颈部肌皮瓣喉再造发音重建术的探索

目的探讨颈部肌皮瓣喉再造术的方法和操作要点。方法2000年10月—2003年9月间对11例喉全切除术后患者行颈部肌皮瓣喉再造发音重建术。用颈部肌皮瓣连接下咽和气管，形成类似“会厌”和“声带”的结构，由此达到能发音、呼吸且无明显呛咳的目的。结果全部患者术后都较好的恢复了发音，且音量音质接近正常人，呛咳等并发症轻微。结论该手术操作较简单，效果确切，后遗症小，是一种较好的喉再造术式。     

182例骨盆恶性骨肿瘤微波高温灭活保肢术围手术期的护理体会

目的：探讨骨盆恶性骨肿瘤微波高温灭活保肢术患者的围手术期相关护理,提高手术成功率,降低各种并发症的发生率。方法：1998年-2008年,对182例接受骨盆恶性骨肿瘤微波灭活保肢术的患者术前、术后给予心理干预,制定完善的护理计划,密切观察病情变化,预防并发症的发生,指导康复功能锻炼。结果：做好围手术期的管理有利于患者的康复,减少并发症的发生。结论：围手术期对骨盆恶性骨肿瘤微波灭活保肢术至关重要,术前进行心理疏导,调整身体营养状况,完善各项术前准备,术后密切观察生命体征及肢体的神经恢复情况。注意手术切口和引流管的维护,加强皮肤的管理,早期进行肢体关节功能锻炼,防止感染、静脉血栓等并发症的发生。     

Oesophageal speech following total laryngectomy

Following laryngectomy, there is a resultant increase in longivity of life, that makes it mandatory that the laryngectomized patient finds his rightful place in society. The development of successful oesophageal speech is not only important from the psychological point of view of the patient gaining confidence in being able to express himself, but also from the employment point of view. In our country where a majority of the patients come from poor economic status, the latter assumes a great significance in the overall rehabilitation. Unfortunately, not all patients are able to develop good oesophageal speech. This paper will attempt to investigate some of the factors which might contribute to the success or failure of the development of speech in a laryngectomy patient.