发音重建技术在喉癌手术中的应用

目的:介绍全喉和部分喉切除术后重建发音功能的几种方法。方法:全喉切除后进行气管食管瘘手术建立发音功能,垂直半喉或垂直超半喉切除术后应用转移带蒂胸骨舌骨肌或胸骨舌骨肌骨瓣形成发音皱襞和喉框架结构重建发音功能,近全喉切除术后应用残余喉黏膜制作发音管结构建立发音功能。结果:气管食管瘘手术6例,术后成功发音5例;转移带蒂的胸骨舌骨肌制作人造声带并利用甲状软骨膜修复喉内创面7例,6例术后发音基本满意;8例行带蒂胸骨舌骨肌舌骨瓣重建声带和喉框架结构的患者,术后发音呼吸均无困难;喉发音管重建(pearson式手术)7例,术后发音效果一般,但患者自我评价满意。结论:全喉或部分喉切除后应同期完成喉发音重建手术,以提高术后生存质量。在部分喉切除术中,利用带舌骨的胸骨舌骨肌瓣修复重建喉软骨框架结构和声带皱襞,可以有效避免喉狭窄和提高术后发音质量。

Application of the pronunciation reconstruction technique in the operation of larynx cancer

Objective:To introduce a few kinds of methods of rebuilding voiced functions after the whole larynx and parts of larynx resections.Methods: The voiced functions were set up by trachea oesophagus fistula operation after the whole larynx resection,and by breastbone-hyoid muscle with pedicel or breastbone-hyoid muscle pedicel with hyoid transferred to form pronunciation plica and larynx frame structure after the operation of the plumb half larynx or the plumb over half larynx,and by remnants larynx mucosa used to make a voiced construction after resection of mostly larynx.Results: There were six cases treated by trachea oesophagus fistula operations and five cases among them were successful.There were seven cases,whose the breastbone-hyoid muscles with pedicel were transferred to create man-made vocal cords and thyroid cartilage membrane were used to repair wound inside the larynx,six cases among them were successful.Eight patients had no difficulties to pronounce and breathe after operation,which was to rebuild vocal cord and to larynx structure by breastbone-hyoid muscle with pedicel and hyoid petal.There were 7 cases operated by the larynx pronunciation tube rebuild(pearson's operation),whose effects of pronunciation were general after operation and whose evaluations on their own were good.Conclusion: To improve postoperative existing quality,surgical operation of larynx pronunciation reconstruction should be completed when the whole larynxes or parts of larynxes were resected.During partial laryngectomy,larynx gristle structure and vocal cords plica rebuilt by breastbone hyoid muscle petal with hyoid can effectively avoid a larynx narrow and improve pronouncing quality after operations.