全喉切除术后食管音气流注入位置的临床研究

The study on the position in airflow influx of esophageal phonation after total laryngectomy

目的探讨全喉切除后最佳发音位置与可行的措施。方法全喉Blom-Singer术式发音重建患者中的22例和抽取未行发音重建的患者9例,分为发音组、失音组和对照组,测三组在食管入口下1、2cm和4cm水平的压力,进行食管充气发音试验和言语质量的主观评估。结果失音组、发音组和对照组在食管入口下1cm处均低且接近。行食管充气发音实验显示:发音组、失音组和对照组在食管入口下0.5-2.0cm均可发音称发声阳性区,并可找到最佳发声部位,该部位发声组位于食管下2.0cm,失声组位于食管下1.0cm,对照组位于食管下1.0cm。在最佳发音位置的言语质量的主观评估显示:发音组在言语清晰程度和交流程度两个方面与失音组差异有统计学意义(P<0.01),对照组与发音组差异无统计学意义;在言语流利程度和换气声音强弱方面三组差异亦无统计学意义。结论发音位置与压力相关,压力过高是导致失音的一个重要因素,为全喉切除发音重建方式的设计提供了重要理论依据。

Objective To discuss the best position of the phonation prosthesis after total laryngectomy and the possible way to improve method. Methods All objects were chosen from the patients with laryngeal carcinoma and received total laryngectomy. 22 patients were randomly chosen from obtained Blom - Singer phonation rehabilitation. Among them 12 cases who can speak defined as speech group and 10 cases who can not speak defined as nonspeech group. In addition, we chose randomly 9 patients who did not obtained phonation rehabilitation after total laryngectomy defined as contrast group. We measured the pressure of upper intraesophagus, esophagus insufflation test and evaluated the characteristics of speech respectively. Results There was lower pressure and no significant difference 1 cm below entrance of esophagus among the three groups. The esophageal insufflation test suggest there was phonation area 0. 5 -2 cm below entrance of esophagus among the three group, in which we can find the best phonation position. Conclusion The pressure of upper intraesophagus is the main factor for failure to obtain phonation.