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。     

喉全切除术后Blom-Singer法发音重建术并发症分析及处理

目的 探讨喉全切除术后安放Blom-Singer发音管发音重建术的并发症及处理策略。方法 回顾性分析1986年11月—2004年6月期间151例喉全切除术后患者安装Blom—Singer发音管的临床资料。结果 所有病例均随访6个月～15年。151例中，138例获得满意的发音效果，发音总成功率91．4％；出现并发症15例，发生率9．9％，其中造口肉芽增生6例，4例行激光切除，2例三氯醋酸烧灼去除，其中有2例发音失败；早期感染2例且并发咽后壁脓肿，其中1例累及上纵隔，均经局部切开负压引流及应用抗生素治愈；2例管周漏液，取出发音管一段时间后，造口缩窄，重新置入发音管；发音管脱落2例，重新置入；造口狭窄1例，行造口扩大术得以解决；发音管食管端鸭嘴部真菌生长1例，制霉菌素清洗，后更换发音管；误吸1例，封闭造口后患吸入性肺炎。15例并发症中成功治疗12例，余3例发音失败。结论 气管食管穿刺安放Blom-Singer发音管帮助喉全切除患者恢复语言功能，并发症少，成功率高，发声质量好，目前已成为一种最常用的手术方法。     

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.     

Amatsu法发音重建术60例评价

目的 评价Amatsu法发音蕈建术的临床效果.方法 60例喉全切除、双颈淋巴清扫术患者一期行Amatsu法发音重建术,其中喉癌49例,下咽癌11例;1例术前放疗80 Gy,20例术后放疗60～70 Gy.术后随访3～6年,评价言语、吞咽功能.结果 52例(86.7%)术后均获得良好的言语功能,其中吞咽功能正常51例,另1例进食流食时可见气管内少量滴漏.8例(11.3%)发音重建失败,吞咽功能均正常:4例因并发咽瘘(其中术前放疗1例),经换药、抗感染处理后咽瘘均痊愈,吞咽功能正常,但已敛发音管坏死,发音失败;2例因气管食管造口粘连致发音管闭锁,未再行补救性手术,改用人工喉发音;1例不明原因呼吸困难;1例无发音意愿.20例术后放疗者言语功能有暂时性影响,均恢复良好.结论 Amatsu法发音重建术可一期重建喉全切除患者的言语和吞咽功能,可获得良好的发音效果,术后放疗不影响患者的远期发音效果.     

全喉切除Ⅰ期气管食管端-侧吻合发音重建术远期疗效分析

目的 :探讨一种有别于其他全喉切除术后发音重建术的手术方法。方法 :施行全喉切除术后行Ⅰ期气管膜样部食管前壁造孔端 侧吻合气管食管分流发音重建术 36例。结果 :随访 5～ 10年 ,1例失访 (按死亡计算 )。36例中 ,近期发音成功率为 6 9.4 % ,远期为 83.3% ;3年存活率为 72 % ,5、10年存活率为 6 9%。结论 :该发音重建术不影响全喉切除的彻底性 ,Ⅰ期完成 ,操作简单、误吸率较低、发音成功率高、远期效果稳定 ,是一种让全喉切除术后患者开口讲话的较好的手术方法     

48例喉全切除气管断端膜样部食管吻合分流发音重建术长期疗效观察

目的　研究喉全切除气管断端膜样部食管吻合分流发音重建术的长期疗效。方法　利用自制的随访表 ,对白求恩国际和平医院 48例患者做长期随访 ,其中喉癌行喉全切除发音重建术 46例 ,下咽癌行喉全切除发音重建术 2例。观察他们的发音和吞咽情况 ,并对手术并发症和生存率做了统计分析。结果　 35例无喉者的言语水平接近正常喉言语水平 ,他们的最大发音时程较长、听距较远、言语可懂度高、较流利。 5例发音效果较差 ,但言语可懂度仍高。发音成功率 83 3% (4 0 / 48)。成功组中 ,40 0 %无喉言语者 (16 / 40 )有不影响正常进食的轻微误吸。另 8例不能发音 ,也没有误吸。气管瘘口、气管 食管分流口感染和咽瘘是影响发音重建成功的重要因素。生存率与单纯喉全切除术相当。结论　该术式一期完成 ,操作简单 ,发音成功率高 ,一些病例虽有轻微误吸 ,但不影响正常进食 ,值得推广运用     

51例喉全切除术的临床分析

目的：探讨喉全切除术及发音重建术的临床应用价值及疗效。方法：对1988年1月--2001年12月间51例喉癌及喉咽癌施行喉全切除术及部分施行发音重建术的病例进行回顾性分析。结果：51例全部施行喉全切除术，其中17例行气管(环)咽吻合术，发音成功率88．2％(15／17)。6例行新喉再造术，发音成功率100％。3例行食管气管造瘘术，发音成功率66．7％(2／3)。25例行气管皮肤造口术(咽-食管发音)，发音成功率52％(13／25)。手术主要并发症咽瘘的发生率为17．6％(9／51)。5年生存率为64．7％(33／51)。结论：喉全切除术仍不失为治疗各种中、晚期喉癌及喉咽癌最基本、最安全的手术，特别是在喉全切基础上选择施行各种发音重建术，对病人恢复发音功能，提高病人生存质量，具有广泛临床府用价值。     

Blom-Singer发音管在喉全切除术后的临床应用

目的观察喉全切除术后应用Blom-Singer发音管重建喉发声功能的效果。方法回顾性分析1994年9月～2003年8月15例喉全切除术后行Blom-Singer发音管重建喉发声功能患者的临床资料。结果15例患者中12例行Ⅰ期发音管重建术，10例手术成功(10／12，83．33％)；3例行Ⅱ期发音管重建术，其中2例手术成功，两种术式的总成功率为80％(12／15)。Ⅰ期手术失败2例，与气管食管壁分离过多有关；Ⅱ期手术失败1例，系环咽肌切断不完全所致。结论喉全切除术后应用Blom-Singer发音管重建喉发声功能是一种有效的发声重建方法，环咽肌切断及保留气管食管壁的完整是手术成功的美键。     

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。     

48例喉全切除气管断端膜样部食管吻合分流发音重建术长期疗效观察

目的 研究喉全切除气管断端膜样部食管吻合分发音重建术的长期疗效。方法 利用自制的随访表，对白求恩国际和平医院48例患者做长期随访，其中喉癌行喉全切除发音重建术46例，下咽癌行喉全切除发音重建术2例。观察他们的发音和吞咽情况，并对手术并发症和生存率做了统计分析。结果 35例无喉者的言语水平接近正常喉言语水平，他们的最大的发音时程较长、听距较远、言语可懂度高、较流利。5例发音效果较差，但言语可懂度仍高。发音成功率83．3％（40／48）。成功组中，40．0％无喉言语者（16／40）有不影响正常进食的轻微误吸。另8例不能发音、也没有误吸。气管瘘口、气管－食管分流口感染和咽瘘是影响发音重建成功的重要因素。生存率与单纯喉全切除术相当。续集 该术式一期完成，操作简单，发音成功率高，一些病例虽有轻微误吸，但不影响正常进食，值得推广运用。     

Voice rehabilitation following laryngectomy. Myomucosal tracheoesophageal shunt

Surgical procedures for speech rehabilitation following laryngectomy lack wide support owing to tumor recurrence, aspiration, stenosis of the fistula, and multiple surgical stages of limited usefulness in irradiated patients. The recent prostheses and their modifications have approximately a 70% success rate but similarly remain limited by the requisite maintenance and soilage. A mucosa-lined tracheoesophageal fistula with a functioning proximal muscle sphincter, created in one stage at laryngectomy, is described. This myomucosal unit can function with or without a prosthesis and potentially eliminates aspiration. Evolution of the flap design in an animal model is delineated and the clinical trial in six patients high-lighted. Five of the six have an excellent vocal quality without an associated air leak on phonation. Three function without a prosthesis.     

Speech rehabilitation after laryngectomy with the amatsu tracheoesophageal shunt

The Amatsu vocal rehabilitation technique is a tracheoesophageal shunt using a posterior tracheal flap associated with a sphincter made of esophageal muscular wall. Since march 1991 the procedure was done in 33 men and 2 women. ages ranging from 30 to 78 years. Previous radiotherapy, hypopharynx lesions, need for postoperative radiotherapy or use of myocutaneous flap were not considered contraindications. Vocalization was achieved in 76% of our patients and the quality was considered superior than that obtained by the esophageal voice. In only one case the shunt had to be closed surgically because of aspiration. In conclusion, the Amatsu tracheoesophageal shunt is an inexpensive technique that obtain a good quality of vocal rehabilitation in a high percentage of patients, it has few complications and it should be considered for all candidates to a laryngectomy, mainly for those with a good prognosis and a desire to return to their social environment.     

Tracheoesophageal puncture with tracheal tube and flexible endoscope

Tracheoesophageal shunt phonation is one method of voice restoration after total laryngectomy. Singer and Blom reported an endoscopic technique for voice restoration after laryngectomy, but this is not easy for all cases, because introducing nonflexible endoscope is difficult due to of scarring in the neck and reconstruction with free jejunum. We conducted tracheoesophageal puncture with a tracheal tube and flexible endoscope, finding this useful for all cases of secondary shunt procedures.     

Near total laryngectomy with internal vocal shunt by Pearson

First experience in near total laryngectomy with internal vocal shunt was shown. The applications and surgical technique of this method was described. The function of the vocal shunt in terms of swallowing, deglutition and phonation using endoscopic and radiological examination was presented. Based on previous papers the alternative methods of vocal surgical rehabilitation after laryngectomy was compared. We have emphasized advantage of this operation in selective cases of the laryngeal carcinoma and/or carcinoma of the piriformis sinus as well.     

Voice evaluation of myomucosal shunt after total laryngectomy: comparison with esophageal speech

The vocal quality attained with a tracheoesophageal myomucosal shunt (MMS) as described by Strome was evaluated in four patients and compared with three esophageal speakers and two normal subjects. The patients with MMSs acquired speech sooner. Fundamental frequency, pitch, timbre, and melody were analyzed with computerized electroglottography and sonography. Intelligibility was deemed better after the MMS primarily because phonation time approximated that of normal speech, and this study suggests that, following total laryngectomy, the vocal quality achieved using the MMS is preferrable to that of esophageal speech.     

Near total laryngectomy: the problems influencing functions and their solutions

We investigated the problems affecting functional outcomes of near-total laryngectomy and their solutions. A retrospective analysis about complications (i.e., aspiration, pharyngocutenous fistula, shunt stenosis, etc.) that affect postoperative functions was made by using the medical records of 23 male patients (mean age: 56.6, range: 35 to 72 years) who underwent near total laryngectomy. Maximal phonation times of 17 patients and fundamental frequencies of 10 patients were measured and compared with control groups consisting of sex- and age-matched normal laryngeal speakers. Pharyngocutenous fistula occurred in five cases and closed by secondary wound healing. The incidence of aspiration was 42%. Shunt stenosis wasnt observed in our cases, but loss of phonation occurred because of tumor recurrence at the neoglottal region in the 1st postoperative year of one patient. All patients were able to produce voice, and communicable speech was achieved by 19 (82.6%). Measurements of maximal phonation time indicated a significant decrease in the NTL group. The increase in fundamental frequency values of the near total laryngectomy group was also found significant in relation to the control group. After careful patient selection, extreme effort should be made to create a dynamic shunt and complete mucosal covering of the inner surface of the shunt in near total laryngectomy, thus not only producing voice without aspiration or shunt stenosis, but also providing oncologic safety in the patients with sufficient vital capacity.