喉全切及近全切术后发音重建及发音功能的评价

Phonation Reconstruction and Function Assessment after Total and Near-total Lar yngectomy

背景与目的:喉全切除术是治疗喉癌及下咽癌的常用术式,但术后患者会丧失发音功能。本研究回顾改良Amatsu与改良Pearson手术在喉癌及下咽癌患者中的应用,并且对其术后发音质量作出主客观评价。方法:对1996年～2003年69例在我科行喉全切除和喉近全切除术后发音重建的患者进行回顾性分析,采用嗓音学分析及Jiyan分级评分法,对其发音质量同喉垂直部分切除术(VHL)和健康人相比较。结果:69例患者均未发生明显的误吸。术后放疗4例,发音均成功。在3年随访的病例中,25例行喉近全切除术有22例生存。在5年随访的病例中,5例喉近全切除术有4例生存。嗓音学分析及Jiyan分级评分法提示改良Amatsu与改良Pearson术后患者的发音可以满足日常生活需要。结论:改良Amatsu与改良Pearson手术操作方便,易学易用,尤其是改良Pearson手术可作为选择术式之一。

BACKGROUND &OBJECTIVE: Total laryngectomy is a common surgery pa tt ern for treating laryngeal and hypopharyngeal cancer, but patients will lost pho nation function after operation. This study was to retrospectively analyze usage of modified Amatsu, and modified Pearson operation in treating laryngeal and hy popharyngeal cancers, and to analyze phonation function by subjective and object ive assessment. METHODS: Clinical data of 69 patients with laryngeal or hypophar yngeal cancer treated by total or near-total laryngectomy (modified Amatsu or m odified Pearson operation) in our department from 1996 to 2003 were retrospectiv ely analyzed. Phonation function of 69 patients was evaluated by acoustic analys is and Jiyan classification method, and compared with phonation quality of patie nts received vertical hemilaryngectomy (VHL) and healthy people. RESULTS: No pat ient appeared obvious aspiration. Four cases with post-operative radiotherapy a ll regained phonation function. The 3-year survival rate was 88%(22/25); 5-ye ar survival rate was 80%(4/5). Results of acoustic assessment, and Jiyan classi fication method indicated that phonation function of patients received modified Amatsu or modified Pearson operation could meet daily requirements. CONCLUSIONS: Modified Amatsu and modified Pearson operations can be learnt and applied easil y for phonation reconstruction after laryngectomy. They may be optional surgery patterns, especially modified Pearson operation.