双瓣式发音钮全喉切除术后发音重建

为解决无喉者发音问题，从１９９３年３月～１９９６年１１月，利用自行研制的双瓣式喉发音钮及安装器为全喉切除术后患者应用９７例，其中男８４例，女１３例，年龄３５岁～７８岁。全喉切除术后Ⅰ期安装２０例，Ⅱ期安装７７例，效果满意，患者均能清晰说话，语言流利，地方语言特色明显。部分患者能唱歌，随访观察：在发音钮有效使用时间（１～２年）内，配戴满２年者６８例，发音有效率１００％，误咽率为零。该发音钮具有安装、更换方便，使用时间长，术后不用鼻饲等优点，为无喉者发音提供了又一有效途径。     

喉全切除术后发音钮的研制及临床应用115例

目的 探讨喉全切除术后发音钮的研制、安装及临床应用.方法 作者自行研制一种用硅胶制成的发音钮.115例喉癌患者喉全切除术后安装了发音钮,一期安装87例,二期安装28例.结果 随访0.5～10.0年,能够流利、清晰讲话者105例,成功率91.3%,无明显并发症.结论 喉全切除术后发音钮的应用,能让安装患者讲话清楚、流利,保持原来的语言特点.该方法成功率高,操作简便,适应证广.     

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.     

喉全切除发音重建术远期疗效分析

为了评价喉全切除术后发音重建术的效果，１９７７年８月到１９９４年１２月，对喉癌患者共行各类喉全切除发音重建术１２５例。男１１９例，女６例，年龄最大７０岁，最小３０岁，平均５５．３岁。临床分期：Ⅱ期２例，Ⅲ期４５例，Ⅳ期６６例，治疗后复发１２例。喉重建术式有：咽气管吻合术１８例，气管－食管造瘘术１０７例，后者包括直接法３４例（其中１２例安装发音钮），管道法１９例，瓣膜法５４例。１２５例中除１１例失访外，皆获随访，最长１８年，最短１３个月，３、５、１０年生存率分别为：７８．２％，６１．４％，４０．５％。按听距法评价发音效果，总有效率：术后３周：８４．６％，１年：８１．１％，５年：６７．５％。发音重建失败的原因有：术后造瘘口闭锁１５例，术后误咽而关闭瘘口８例，原因不明３例。喉全切除发音重建术可明显改善发音功能，合并症少，有较高的临床使用价值。     

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.     

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。     

喉发音钮术后痉挛性发音障碍

喉发音钮术后痉挛性发音障碍丁浩，刘清明，韩在文，赵立民喉全切除术后用发音赝复物重建发音具有发育清晰、易懂、应用范围广、安装成功率高及使用方便等优点，但亦可见并发症或痉挛性发音障碍。我科于１９９０年用自行研制新型硅橡胶发音钮用于全喉切除患者，发现８例痉...     

喉切除术后3种发音重建术的发音强度测定

目的 测定喉切除术后的3种发音重建术的发音强度。方法 用声级计测定发音强度。结果 全喉切除术后安装发音钮14例，发音强度达55-65db者6例（42.8%）；全喉切除后气管上端食道粘膜声门重建9例，发音强度达55-65dB者2例（22%）；次全喉术后气管咽发音管成形31例；发音强度达55-65dB者19例（61%）。结论 喉切除3种发音重建术，以次全喉切除气管咽发音管成形术的发音强度较好。     

全喉切除术后发声重建18例发音训练及体会

喉癌是耳鼻咽喉一头颈外科常见的恶性肿瘤之一．自１８７３年Ｂｉｌｌｒｏｔｈ开展第一例全喉切除术以来，不断有学者研究对无喉患者进行语言康复。我院自１９９４年开展气管食管分流术，１９９７年开展Ｂｌｏｍ－Ｓｉｎｇｅｒ发音管安装术，共１８例，现就术后发音训练及体会介绍如下。ｌ 临床资料ｌ．１ 一般资料：全部为男性，年龄５５～６８岁。手术前后病理均为鳞癌。单纯全喉切除术１５例，全喉加颈清扫术３例，其中术后放疗３例。ｌ．２ 手术方法：６例食管气管分流术式按李树玲“术式”。１２例Ｂｌｏｍ－Ｓｉｎｇｅｒ发音管安装术…     

喉癌切除后发音重建的临床研究

本文就１９７５年￣１９９５年８月间收治的资料完整的９５例喉癌手术方式、喉功能恢复及生存率进行分析。９７．９％（９３／９５）的患者吞咽功能良好，８０．０％（７６／９５）发音良好。部分喉切除拔管率为５９．５％（２２／３７）。全喉切除术１、３、５年生存率分别为８８．１％、８２．４％、７６．９％；部分喉切除术１、３、５年生存率分别为８６．７％、７８．３％、６８．４％。按临床分期统计生存率：Ｉ￣Ⅱ期患者１、     

Traissac voice prosthesis. Apropos of 9 years experiences

BACKGROUND: Long term results are discussed. PATIENTS: A retrospective study of 9 years (1/01/89, 1/01/98) concern 107 laryngectomized patients with 9 patients a part from this period, and 30% without prosthesis. Among 80 patients with prosthesis, 57% had received primary TEPs (tracheoesophageal puncture), 21% delayed primary TEPs and 22% secondary TEPs. Oesophageal voice is always learned with tracheoesophageal voice. RESULTS: We find a success rate (1 month) in 75% of cases, with a maximum follow up time of 8 years (the average is 3 years 1 month). We find a success rate with a long-term result in 66% of cases. Prosthesis removal exists in 30% of cases and oesophageal voice is successfull once out of 3 in this cases. Mean lifetime Traissac's prosthesis is 18 months. After removal, non closed fistulas can exist in 40% of cases, and surgery is always successful. DISCUSSION: Material Traissac's prosthesis explains extended lifetime. CONCLUSION: Traissac's prosthesis gave us satisfaction during a use of 8 years.     

Neues Punktionsinstrumentarium: Provox-Vega®-Punktionsset

Background

The use of voice prostheses has been considered the gold standard in voice rehabilitation following laryngectomy for the last 20 years. Insertion is generally performed as a primary procedure during laryngectomy or as a secondary procedure with a re-usable trocar or rigid esophagoscope, a guidewire and anatomic hemostatic forceps. The use of these instruments requires a certain level of experience on the one hand, while on the other use of a trocar and subsequent manipulation with the hemostatic forceps can lead to tissue trauma around the membranous wall or damage to the voice prosthesis. We present the results of a phase I/II study using a novel atraumatic puncture set for primary and secondary insertion of voice prostheses.

Patients and methods

Once patients had been fully informed and given their consent, the Provox-Vega® puncture set was used in 21 patients in either a primary (16) or a secondary (5) procedure. All procedures were documented on video, while approach, complications and surgical success were recorded using a questionnaire.

Results

The average surgical time was 83.5 (±?19.12) s for primary voice prosthesis insertion and 212.57 (±?93.03) s in secondary procedures. The prosthesis could be inserted without complication in 19 patients, while a longer prosthesis needed to be selected intraoperatively in two patients due to a thick membranous wall. No serious complications were observed. One patient incurred a discrete injury to the mucosa of the esophageal posterior wall.

Conclusion

The Provox-Vega® puncture set proved itself to be a safe aid in the insertion of voice prostheses. It is significantly easier to use than other systems and tissue trauma is minimal. In most cases, no further instruments were required.     

食管音气流注入位置筛选与新发声方式的研究

目的：探讨全喉切除后寻找最佳发声位置与可行的措施。方法：全喉切除安装发音管健在的33例患者,有12例不能发声,选择10例作为失声组;在发声病例中选择10例性别、年龄、病理类型、手术方式较接近者为发声组。分别进行食管上端测压、充气发声试验、吞钡检查及纤维喉镜检查。结果：前鼻孔至食管入口、最佳发声位置、发音管水平距离两组均无差异。发声充气试验显示,发音管水平失声组无一例发声阳性;发声组7例阳性,3例阴性。最佳发声位置,失声组在发音管水平上方3．6cm,发声组在2．0cm处。食管上端测压显示,食管入口下1．0cm与发音管水平下2．0cm压力较低,2组差异无统计学意义（P〉0．05）。发音管水平压力较高,2组差异有统计学意义（P〈0．01）。失声组4例简易型食管音发声器试用均可发声,发声组中1例应用亦能发声。结论：发音管平面、失声组压力明显高于发声组,是不能发声的主要因素。2组在食管入口下方可找到最佳发声位置,该位置下方是压力最高的发音管平面,可有效阻止气流向下进入胃内,从而解决了失声组不能发声的问题,提高了发声成功率。若使发声气流到达该处,可通过手术;发音管改革;食管音发声器均可将气流引入该处。     

Voice restoration by primary insertion of indwelling voice prosthesis following circumferential pharyngolaryngectomy with free jejunal graft

BACKGROUND: Voice restoration after circumferential pharyngolaryngectomy (CPL) with free jejunal graft remains a difficult problem to solve. Few reports have analyzed the success rate and complications following primary insertion of indwelling voice prostheses during CPL with free jejunal graft. PATIENTS AND METHODS: Eight patients who underwent CPL with free jejunal graft had a Groningen voice prosthesis inserted as a tracheoesophageal (TE) shunt at the time of oncological surgery. A 10-point scale was used to assess each patient's speech intelligibility. Complications following the voice prosthesis insertion were also analyzed. RESULTS: Six of the eight patients (75%) achieved excellent speech intelligibility and the remaining two patients (25%) were judged as moderate. Six of the eight patients (75%) used the TE shunt as their major means of daily communication. Leakage through or around the prosthesis, which occurred in six (75%) patients, was the most frequent prosthesis-related complication. CONCLUSIONS: This safe and reliable technique can be effective in improving the quality of life in selected patients undergoing CPL.     

Chronic aspiration secondary to a Staffieri fistula: successful therapy with Provox voice prosthesis

BACKGROUND: The Staffieri technique is a method for surgical rehabilitation of the voice after laryngectomy. A fistula between trachea and esophagus is created to achieve a so-called "Neoglottis phonatoria". The assignment of the neoglottis is to protect the airways during ingestion and to give the patient a chance to phonate during expiration. PATIENT: The case of a 71-year-old man with aspiration via his Staffieri fistula is presented. The fistula was created in 1979 after laryngectomy because of a laryngeal carcinoma. He also suffered from a metastasized gastric carcinoma which was cured by a 2/3 resection of the stomach in 1970. He is free of recurrence with regard to his oncologic diseases. Until 2003 the patient had no problems with the fistula and was able to phonate well. In 2003 the patient had progressive aspiration via the fistula and the Staffieri fistula was therefore reduced in diameter by surgery. In 2005 the patient presented himself again because of a recurrence of the aspiration. Endoscopy of the upper aerodigestive tract showed healthy mucosa, contrast imaging of the esophagus showed a significant aspiration of the contrast medium into the trachea. Due to these findings a voice prosthesis was inserted into the fistula. This therapy cured the patient from aspiration. He is able to phonate well and has no further complaints. CONCLUSION: Aspiration via a Staffieri fistula is described in about 25 % of cases and therapy is sometimes difficult. Surgical narrowing of the diameter of the fistula is inadequate in most cases and many patients would lose their restored voice if the fistula was closed permanently. Through the insertion of a voice prosthesis aspiration could be stopped and voice was immediately restored.     

Voice prosthesis in patients after total laryngectomy

The aim of the study is to present the role of voice prostheses in the voice rehabilitation in patients who underwent total laryngectomy. 7 patients with laryngeal cancer were included in the study. All patients are males aged 41-72 years (mean age 58) treated in the Department of Otolaryngology Medical Academy of Bialystok from November 2001 to March 2002. The voice prostheses were placed during the total laryngectomy in 5 patients. In 2 patients the voice prosthesis was placed in the period of 1.5 to 2 years after laryngectomy. The voice prostheses type Provox 2 were used in all cases. In 2 cases the prosthesis was in size of 8 mm, in 5 cases--10 mm. The control group included 7 patients after total laryngectomy without placing the voice prostheses. These patients developed oesophageal speech. All patients underwent phoniatric measurements during 12 to 30 days after the surgical procedure. The data indicate that patients who developed oesophageal speech, their voice in the range of subjective measurements is understandable but it is necessary to emphasize that the voice is harsh, low without fluency of the speech result from the intervals essential to accumulate the air in the oesophagus. The patients with voice prostheses have dull voice but more fluent and louder. The clarity of the voice of the patients with voice prostheses is significantly higher. According to the objective measurements all parameters are better in the oesophageal speech.     

Microbial colonization of silicone voice prostheses used in laryngectomized patients.

The aim of this study was to identify the microbial colonization of dysfunctioning voice prostheses in laryngectomized patients and determine the influence of patient radiation therapy on prosthesis life span. In a 40-month period, 257 outpatient voice prosthesis replacements were carried out in a laryngectomized group of 31 patients. The voice prostheses were all removed from the tracheo-oesophageal fistula after dysfunctioning of the prosthesis. Of the replaced prostheses 183 were cultured. The microbial cultures showed a predominant colonization with Candida albicans and commensal oral microflora. Radiation therapy induced xerostomia shortened the lifetime of the first inserted prosthesis in particular.     

The custom-fit voice prosthesis, for treatment of periprothetic leakage after tracheoesophageal voice restoration

BACKGROUND: Leakage around an indwelling voice prosthesis is detected during 13% up to 27% of all replacement procedures of voice prosthesis and causes serious complications in further voice restoration of the laryngectomee. Lots of therapeutic options to stop periprothetic leakage have been described (Injection of Bioplastique, autologous fat or collagen, suture techniques, spacer therapy) without convincing success rates. METHODS: Custom-fit voice prostheses are ordinary indwelling voice prostheses (Blom-Singer low pressure Indwelling 20 fr) with enlarged flanges and reduced shaft length that are individually sized for the shunt of the laryngectomee. Especially enlarging the esophageal flange provides a tight sealing of leakage around the prosthesis. PATIENTS: In a one year lasting clinical trial 692 voice prostheses were changed. In 77 cases periprothetic leakage was detected and fistulas were fitted with individually sized voice prostheses. RESULTS: In 76 cases total control of leakage was achieved without any specific complications taking place. Moreover two types of leaking tracheoesophageal fistulas were distinguished, a dilated-atrophic and an infected-necrotic type. 57% of the fistulas were dilated-atrophic type and 43% of the fistulas were classified infected-necrotic type. Infected-necrotic fistulas needed enlarged flanges tracheal an esophageal for tight sealing in 91% of the cases whereas dilated-atrophic fistulas needed double flanges only in 45%. 70% of infected-necrotic type fistulas needed only one singular history of a custom-fit prosthesis and could be changed back to ordinary indwelling prostheses after healing had taken place. CONCLUSIONS: As the insertion of a modified prosthesis is only slightly more effort than an ordinary voice prosthesis insertion, the success rate is high und complications are rare we recommend the custom-fit voice prosthesis for treatment of periprothetic leakage.