部分喉切除术患者的营养护理

目的:探讨部分喉切除术患者营养支持的护理。方法:对2 5例部分喉切除术患者,从术前的营养支持、术后管饲的护理以及吞咽功能训练三方面进行指导。结果:2 5例部分喉切除术患者营养状况得到明显改善,无发生营养相关的并发症。结论:提示部分喉切除术患者的营养护理能提高机体免疫力,确保患者顺利度过手术康复期。     

X线录相对无喉人食管发音机理的初步探讨

本文对19名无喉人食管发音患者,利用X线电影、X线录相及录音技术,对食管发声的机理进行了图、声同步的动态观察与分析。认为食管发声须经过:科学训练;代声门形成;贮气、送气、发音三个时相过程及口腔、鼻腔、舌唇、齿等构字器官的协调配合加工而成。文中还对此项检查设备、方法、检查前准备及步骤进行了详尽论述。     

TOTAL LARYNGECTOMY WITH PRIMARY VOICE RESTORATION

Forty-three patients were prospectively studied following tracheo-oesophageal puncture at the time of laryngectomy (primary voice restoration). Blom-Singer voice prostheses were used. The surgery was regarded as successful if a patient continued to use the voice prosthesis as the major means of communication with clear intelligibility 4 months after the operation. Using this criterion, the success in this series was 70%. No attempt was made to assess the quality of speech. Complications and causes of failure are discussed.     

An improved technique for treating tracheostomal stenosis following laryngectomy

Stenosis of the tracheostome is an occasional complication following laryngectomy. Having tried a number of procedures recommended for correction of such stenoses with limited results, we developed a new technique. This technique which is based on multiple Y-V plasties has been applied to 20 patients. Measurements of the stomal area following surgery in 18 patients showed an average increase in stomal size by a factor of 3.8. One patient apparently had no increase of the stoma. In 2, no post-operative measurements were available. Post-operative infection resulted in recurrence of the stenosis in one patient. He was successfully reoperated using the same technique. Follow-up revealed that none of the patients had complaints related to their stoma.     

Heat and moisture exchangers as a treatment option in the post-operative rehabilitation of laryngectomized patients

A multi-institutional, prospective clinical study was undertaken to investigate whether the use of a heat and moisture exchanger (HME) in the period following total laryngectomy could prevent the development or reduce the severity of respiratory symptoms. Fifty-nine patients from three hospitals were provided with HMEs, either immediately post-surgery or, in the case of post-surgical radiotherapy, upon completion of the radiotherapy. For the total sample (n= 59) statistically significant improvements over time (between 3 and 6 months) could be found in forced expectoration (P < 0.05), in the perceived voice quality (P < 0.001), social anxiety (P < 0.001), social interactions (P < 0.001) and in feelings of anxiety and depression (P < 0.05). Repeated measures analysis of variance indicated statistically significant group differences over time in forced expectoration and stoma cleaning (P < 0.05). No statistically significant differences over time were noted between the regular and non(regular) HME user groups in voice quality or in various aspects of daily living.     

Recommendations for the reporting of larynx specimens containing laryngeal neoplasms

The Association of Directors of Anatomic and Surgical Pathology have developed recommendations for the surgical pathology reporting of common malignant tumors. The recommendations for carcinoma of the larynx are reported herein.     

全喉切除术后发音重建56例分析

目的：总结喉癌全喉切除术后Ⅰ期安放发音管发音重建的临床经验。方法：分析自1998年9月至2002年5月全喉切除术后Ⅰ期Blom-Singer发音重建56例的发音情况。结果：Ⅰ期安放发音管发音重建成功率92．9％，发音流利、响亮、清晰。结论：全喉切除术后Ⅰ期安放发音管发音重建成功率高。     

全喉切除术中保留甲状软骨膜对手术进程和术后恢复影响的探讨

目的：探讨保留甲状软骨膜对全喉切除手术进程和病人术后恢复情况的影响。方法：在甲状软骨膜下游离甲状软骨并切断其上角。不结扎和切断舌骨下肌群和喉上动脉。保留之甲状软骨膜用以加强修复咽壁黏膜。结果：本组病例较经典全喉切除术手术时间缩短30min以上。手术中出血在100ml以下。患者术后第2d下床活动，第4d开始进食流质。手术创口均一期愈合。结论：全喉切除术中保留甲状软骨膜可有效地简化手术步骤，减少创伤和出血。利用甲状软骨膜加强咽壁黏膜缝合口，进一步减少了咽漏的发生.