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。

Screen for the position in influx of airflow of esophageal voice and the study of the new voice way

Objective:To discuss the best position of the prosthesis after total laryngectomy and the possible way to improve.Method:Thity-three patients with vocal prosthesis after total laryngectomy through April 1994 and July 2004 were selected.Among them,10 cases were selected from 12 nonspeakers were defined as the experiment group;10 cases with the same gender and nationality and closed occupation,age, the type of pathology,ways of the operation were selected from the rest cases who had got voice as the contrasted group.And intraesophageal pressure measurements,esophageal insufflation testing,esophageal barium solution x-ray,laryngofibrescopy were performed.Paired-samples t-test was adopted.Result:The distances from nastril to the entrance of esophagus,the best vocal position and the level of vocal prosthesis have no significant difference between two groups.The esophageal insufflation testing showed there was no one case got the voice in the experiment group and there were 7 cases got voice in the contrasted group.The best voice position of the experiment group were at 3.6 cm above the prosthesis,and the contrasted group were at 2 cm above the prothesis.The pressure of superior esophagus suggested that the pressure of 1 cm below the entrance of esophagus and 2 cm below the prosthesis were lower and there were no significant difference(P>0.05) between two groups,but the pressures of the level of prosthesis were higher and there were significant difference(P<0.01) between them.Conclusion:The pressure at the level of the prosthesis in experiment group were more higher than the contrasted group was the main factors for failure to get voice.The best voice position could be found in both groups below the entrance of the esophagus,and below it was the level of the prosthesis with the highest pressure which could effectively prevent the air from flowing into the stomach. Allow the air flow into the position by operations and the reform of the prosthesis could solve the problem of could not get the voice and improve the rate of success to get voice.