不同舌重建术后患者语音功能的评价

Evaluation of Articulatory Function after Glossectomies:a Comparison of Three Different Reconstruction Methods

目的:评价不同舌重建术式对舌癌患者术后语音功能恢复的影响。方法:32例舌癌患者据重建术式分组:带蒂胸大肌肌皮瓣修复组5人,除1例外舌切除缘范围均过中线;前臂游离皮瓣修复组和邻近组织瓣修复组分别为16人和11人,除1例外舌切除缘范围均不过中线。采用汉语语音清晰度测试和短句测试方法,对患者手术前后语音清晰度变化情况进行分析,并对前臂游离皮瓣修复组和邻近组织瓣修复组的评价结果进行团体t检验。结果:带蒂胸大肌肌皮瓣修复组、前臂游离皮瓣修复组和邻近组织瓣修复组术后的语音清晰度平均下降值分别为26.60、7.84和4.18分,短句测试得分下降值分别为1.60、0.50和0.27分;t检验结果显示,前臂皮瓣和邻近组织瓣修复组的语音清晰度和短句测试得分下降值间无显著性差异(P>0.05)。结论:舌癌手术切除后运用前臂游离皮瓣或邻近组织瓣进行舌重建均能较好地恢复患者术后的语音功能,且两者间没有显著差异;对于舌缺损范围较大尤其是超过半侧舌的患者,采用带蒂胸大肌皮瓣也能够在一定程度上改善患者术后的语音功能。

Objective： To evaluate the patients＇ articulatory function after glossectomies with different reconstruction methods. Methods： The articulation of 32 patients underwent glossectomies was investigated by speech intelligibility test and sentence reading test, 6 months after surgery. Results were compared according to the reconstruction type of tongue （reconstruction with pectoralis major myocutaneous flap, reconstruction with forearm flap or reconstruction with adjacent flap）. Results： In pectoralis major myocutaneous flap group, forearm flap group, and adjacent flap group, the decline of speech intelligibility score were 26.60, 7.84 and 4.18 respectively, and the decline of sentence reading score were 1.60, 0.50 and 0.27 respectively. There was no significant difference between forearm group and adjacent group （P〉0.05）. Con- clusion： Articulatory function can be well achieved by forearm flaps or adjacent flaps reconstruction, and there was no significant difference between these two methods. Articulation of the patients with large tongue defects can also be restored in a desirable degree with pectoralis major myocutaneous flaps.