喉全切除患者应用低阻力型Groningen发音钮的护理

目的探讨喉全切除患者应用低阻力型Groningen硅胶发音钮（下称发音钮）发音效果及护理。方法对11例喉癌行喉全切除术的患者,术中一期安装发音钮8例,二期安装发音钮3例。术后做好发音钮的清洁与固定,指导患者进行发音训练及发音。结果11例患者术后经发音言语训练均达到实用水平,无发音困难和吞咽障碍等并发症,发音钮使用寿命均超过6个月。结论低阻力型Groningen硅胶发音钮术后发音效果好,使用寿命较普通发音钮长。而对患者进行全面系统的发音钮日常维护知识教育,指导其进行循序渐进的发音训练能够保证治疗效果。     

全喉切除及食管发音管装置术的护理

全喉切除是治疗喉癌患者的主要手术方式,但是术后发音重建问题一直为医疗界的一个重要研究课题。近几年长春等地医院喉外科开展的全喉切除及食管发音管装置术,创建了一种手术操作简易、安全可靠、语音效果优于其它方法的术式。我科自1989年2月份以来在省内首次开展此项新业务,先后     

电子喉发音训练对全喉切除术患者发音重建效果的影响

目的 探讨全喉切除术后患者应用电子喉发音的护理及效果.方法 对38例全喉切除术后应用颈型电子喉发音患者进行发音训练.结果 38例无喉者应用电子喉发音均获成功,总有效率100%,优良率94.7%.结论 发音训练有助于全喉切除术后患者应用电子喉发音.     

全喉切除气管粘膜瓣一期发音重建术

目的 探讨中、晚期喉癌患者喉全切后发音重建的方法。方法 对28例中、晚期喉癌患者行喉全切除并采用气管粘膜瓣一期气管食管造瘘发音重建。结果 本组病例中,一例出现轻度误咽,另一例出现严重误咽而影响发音,一例因造瘘口狭窄,另一例因气管粘膜瓣过厚而不能发音。术后发音成功率达25/28(89.29％)。结论 本术式适合于中、晚期喉癌全喉切除后的发音重建。手术操作简便,并发症少、术后发音成功率高,宜于基层医院开展。     

喉全切除喉咽粘膜瓣发音管成形术的护理

晚期喉癌病人，行喉全切除发音重建术常采用食管音、人工喉及安置发音钮的气管食管音。我院1992～1996年参考孙健等[1]术式，采用喉咽粘膜瓣发音管成形术9例，术后1～2年，发音及吞咽功能恢复正常。现介绍如下。1临床资料晚期喉癌9例中男7例，女2例，年龄51～67岁。喉癌病理检验均为鳞癌，行喉全切除术，其中1例同时行颈淋巴结清扫术，1例行舌根组织（约1cm）切除术。2手术方法先在局麻下行低位气管切开造口术，插入麻醉导管后采用静脉复合麻醉进行喉全切除术。在气管与食管间向下分离约1cm，气管后壁行“V”型切除，缝合“V”型缺口，将气…     

全喉切除一期常植式Blom-Singer发音管植入术

目的:探讨全喉切除术后建造不狭窄气管造口及一期安装常植式Blom-Singer发音管的可行性及效果。方法:对13例患者喉全切后一期安装常植式Blom-Singer发音管,气管造口用在断端3点和9点处垂直切开2个气管环后皮瓣插入缝合,及气管切口45度切一斜口与皮肤吻合来扩大。结果:13例气管造口半年后直径都在1.5cm以上,发音良好。结论:喉全切后一期常植式Blom-Singer发音管植入术能获得一个足够大的气管造口,发音良好,减轻了患者痛苦和经济负担,值得推广。     

全喉切除Ⅱ期发音纽植入术患者的围手术期护理

目的 总结全喉切除Ⅱ期发音纽植入术患者的围手术期护理经验.方法 对10例接受Ⅱ期发音纽植入术的患者加强术前全面的评估和呼吸功能训练,术后做好发音纽的日常清洁和维护,发音纽的更换管理,言语康复培训和并发症的观察和处置护理.结果 10例患者均能正常发音,1例因食管高度水肿重新植入更大型号发音纽后能正常发音,患者均未出现严重...     

全喉切除安装发音钮的护理

全喉切除安装发音钮的护理山东省济宁市第一人民医院游秀玲，张秀兰，程志强全喉切除术中安装发音钮手术简单易行，发音成功率高。我院１９９２～１９９４年安装发音钮６例。，现介绍护理措施如下：１临床资料６例男病人，年龄４０～８０岁。喉癌５例（Ｔ３Ｎ０Ｍ０４例，...     

老年喉癌患者全喉切除术后便秘的循证护理

目的探讨1例老年行全喉切除术后便秘患者的循证护理效果。方法根据患者情况提出问题,采用与便秘有关的中英文关键词检索万方数据库、Pubmed、CINAHL、Medline及中国生物文献数据库,获取护理证据;参照实施深呼吸训练、增加腹压方法训练、补充水分、卧床期间腹部按摩、鼓励下床活动、训练规律排便反射、创造良好的排便环境、鼻饲双歧杆菌等措施。结果患者逐步恢复排便的力量,大便秘结逐渐改善,每1～3天规律排软便1次,未再发生便秘。结论应用循证护理可以对老年喉癌患者喉切除后发生便秘根本原因进行探究、寻找证据,最终解决便秘问题。     

喉肿瘤切除及发音重建

目的探讨无气管切开的喉肿瘤切除及发音重建。方法回顾性分析对28例局限于声带的原位癌患者喉肿瘤切除及发音重建的临床治疗资料。结果 28例患者术后均能正常发声,22例切口Ⅰ期愈合、1例切口感染、2例皮下积液、3例皮下气肿延期愈合。术后7~16d出院,随访1~5年,1例复发,其他患者均未复发。结论无气管切开的喉肿瘤切除及发音重建术具有创伤小,愈合快,复发率低,术后发声正常的特点,并且避免了因气管切开引起的各种并发症。     

Acoustic analysis of the voice in phonatory fistuloplasty after total laryngectomy.

A comparative study of the voice with sustained phonation of the vowel /a/ was made in 3 groups of male patients: (1) 20 patients receiving total laryngectomy for epidermoid carcinoma of the larynx who had acquired good voice quality after a phonatory fistuloplasty with a Herrmann voice prosthesis; (2) 20 patients undergoing total laryngectomy for epidermoid carcinoma of the larynx who had learned esophageal speech; and (3) 20 subjects with normal voices. Statistical analysis yielded significant differences in fundamental voice frequency between the 3 groups, with the patients with phonatory prostheses revealing the closest to a normal voice. For other parameters used, such as jitter, shimmer, and harmonics/noise ratio, voice quality with a phonatory prosthesis was similar to that obtained with esophageal speech.     

置入心脏临时起搏器喉全切除患者围术期护理

对3例喉癌并存严重窦性心动过缓、房室传导阻滞患者,于喉全切除术前置入心脏临时起搏器,通过术前精心准备,加强起搏器管理,做好体位护理、气道管理、预防感染、心理护理等措施,结果所有患者手术顺利,取得满意抗心率失常治疗效果,术后恢复良好。     

Reconstruction of the voice after laryngectomy

Voice reconstruction and rehabilitation are important for quality of life for patients after surgical ablation of tumors in the larynx or pharynx. In addition to the esophageal voice, the artificial larynx, and external voice devices, the following procedures have been developed: (1) after laryngectomy with preservation of pharynx, neoglottis or TEP can be performed; (2) after laryngopharyngectomy a forearm flap with TEP, or a jejunal transfer with TEP or voice tube shunt can be selected; and (3) after laryngopharyngoesophagectomy, either pharyngogastrotomy with TEP, or colon segment interposition with TEP can be employed. The voice tube shunt is improving, and allograft transplantation is currently under investigation.     

Examination of swallowing after total laryngectomy using manofluorography

Investigation of postlaryngectomy dysphagia is usually limited to the standard barium swallow. Manofluorography (mano, manometry; fluoro, videofluoroscopy; graphy, picture) is a new technique that permits analysis of simultaneous manometry and videofluoroscopy of deglutition. Manofluorography provides more detailed analysis of the swallowing dynamics during the pharyngeal stage of deglutition than either barium studies or manometry used alone. This study uses manofluorography to examine swallowing in two patient groups, total laryngectomees and total laryngectomees with tongue impairment, to analyze the role of various anatomic components in the swallowing process. Pharyngeal transit times were prolonged in both patient groups studied, with the tongue impairment group exhibiting the longest times. The postlaryngectomy pharynx offered greater resistance to bolus flow. The laryngectomy patients compensated by using increased lingual propulsion, whereas the patients with tongue impairment and total laryngectomy could not. This emphasizes the importance of the tongue in bolus propulsion in the pharynx. Other postoperative changes in swallowing are discussed.     

Primary placement of a voice prosthesis on transposed colon after total pharyngolaryngoesophagectomy.

BACKGROUND: Primary placement of a voice prosthesis may aid rehabilitation after total laryngectomy. Methods: We present a rare clinical situation of a T4 NO MO squamous cell carcinoma of the hypopharynx and esophagus in a patient who had previously undergone a transmesocolic Billroth II gastrectomy. RESULTS: The patient benefited from a total pharyngolaryngoesophagectomy, with reconstruction using a transverse-descending colon transposition, and primary placement of a low-pressure voice prosthesis. CONCLUSION: Primary placement of a voice prosthesis may be successful even in a patient who requires extensive pharyngoesophageal reconstruction using transposed colon. To our knowledge, there has been no previous report of primary placement of a voice prosthesis on a colon autograft.     

Primary versus secondary tracheoesophageal puncture for speech rehabilitation in total laryngectomy: long-term results with indwelling voice prosthesis.

OBJECTIVE: To evaluate the long-term use of indwelling Blom-Singer voice prosthesis (VP) for vocal rehabilitation of patients submitted to total laryngectomy (TL). The influence of the timing (primary or secondary) of tracheoesophageal puncture (TEP), use of radiotherapy (xRT), patient age, and length of follow-up were studied to evaluate the success rate of VP use. STUDY DESIGN AND SETTING: Prospective clinical study in a tertiary referral center. Seventy-one patients were submitted to TL and rehabilitated with indwelling VP. All patients were evaluated for vocal functional issues by an otolaryngologist and a speech pathologist at 1 month, then at every 3 months up to 1 year, and then at every 6 months after 1 year of follow-up. The relative data on time of placement of VP, time of VP use, xRT, age, length of follow-up, and life span of each VP were recorded during the follow-up. RESULTS: Eighty-seven percent of the patients underwent primary and 13%, secondary TEP. The follow-up varied from 12 to 87 months, with an average of 38 months for primary and 51 months for secondary TEP. Fifty-nine percent of the patients were submitted to xRT. The general rate of success was 94%, with 97% for primary and 78% (P = 0.07) for secondary TEP; after 2 years, the success rate was 96% for primary and 75% for secondary (P = 0.07) TEP. The use of xRT and patient age had no influence on the success of VP use for primary and secondary TEP, independently of the length of follow-up. CONCLUSIONS: The success rate of voice rehabilitation with VP was 94%. In primary TEP, the success rate was 97%, whereas in secondary TEP it was 78%; 2 years later, it was 96% and 75%, respectively. A tendency for a higher success rate in voice rehabilitation after TL was observed in primary TEP. The use of xRT and age of patient had no influence on the success rate.