咽成形术失败后再次手术后语音功能的评价

Evaluation and treatment in secondary pharyngeal flap surgery of speech function

目的:客观评价咽成形术失败后语音障碍患者可以弥补治疗的方法。方法:对6例一期咽成形术后失败患者,再次实施咽后壁组织瓣转移术,术后进行详细观察和随访,并在术后4周开始吹气训练、行为疗法、语音治疗;对每例患者术前、语音治疗前后行汉语语音清晰度、吹气和冷镜检查,同时用CSL比较其音声特征的变化。结果:6例患者术后供区和受区伤口均一期愈合,腭咽闭合功能(VPC)明显改善,经语音治疗后,患者的语音清晰度达到或接近正常。结论:咽成形术失败后再次手术能补救一期咽成形术后失败的部分病例,除应该严格掌握咽成形术失败后再次手术的适应证外,术者熟练的操作技能也非常重要,同时术后语音治疗必不可少。

PURPOSE:The purpose of this study was to explore the effective treatment method of patients with failed pr mary pharyngoplasty by executing secondary posterior pharyngeal flap for reconstruction of velopharyngeal closure. METHOD: 6 patients with failed operation (posterior pharyngeal flap or sphincter pharyngoplasty), underwent secondary posterior pharyngeal flap operation. They began blowing training and accepted speech therapy 4 weeks after operation. The quantitative measurement of Chinese speech intelligibility, blowing test and steel mirror was carried out at three stages (before operation, before speech therapy and after speech therapy). The sensitive utterance of patients was also analyzed and compared with CSL (Computer Speech Lab). RESULTS: The wounds of each patient recovered perfectly. Velopharyngeal closure and Chinese speech intelligibility of them were obviously better than that before operation, and there were significant distinction of phonetic image on CSL. After speech therapy, they did not differ from normal in velopharyngeal closure and Chinese speech intelligibility. CONCLUSION: Secondary posterior pharyngeal flap operation can effectively salvaged failed primary pharyngoplasty, but it was very important to select indications and avoid complications.