全喉切除-功能性气管食管瘘发音重建术9例临床分析

The Clinical Analysis of 9 Cases by Total Laryngectomy-functional Tracheoesophageai Shunt for Vocal Rehabilitation

目的探讨中晚期喉癌全喉切除、气管食管瘘发音重建术临床疗效。方法对于我院收治的9例中晚期喉癌患者，施行全喉切除、气管外置及功能性气管食管瘘发音重建术治疗的临床资料，进行回顾性分析。结果9例喉癌患者手术均一期完成。一期愈合7倒：创口部分感染2例，经积极抗感染、换药后治愈。术后2-3周始进行发音训练，随诊1-3a，发音效果：I级3倒，II级4例，III级2例。其中2例于2月时饮水偶呛。经头低住咽下均可避免。1例（创口感染者）术后8月饮水呛咳，组织瓣挛缩，故闭锁瘘口，改练食管发音。结论对中晚期喉癌适合全喉切除的患者，进行全喉切除一功能性气管食管瘘发音重建术的治疗，既能达到根治喉癌的目的，又能恢复发音功能，且能保留原来语音特点，音质优美。语音流畅自如，效果持久，更有效地提高患者的生活质量，并发症少。效果满意。值得临床推广应用。

Objective To study the clinical curative effect of total laryngectomy-functional tracheoesophageal shunt for vocal rehabilitation in the middle stage or the advanced stage. Method Retrospective analysis was applied in the clinical information about 9 functional tracheoesophageal shunt for vocal rehabilitation after total laryngectomy in our hospital. Result Operations were given on 9 eases of patients, 7 of which were primary healing and 2 were wound infection. Patients getting an infected wound were cured by resisting infection and dressing change. 2 to 3 weeks after the operation patients had speech training with 1-3 years following up. Among 9 cases on pronunciation effect, 3 cases reached Grade I, 4 cases Grade 1] and 2 cases Grade IK .2 cases of patients choked sometimes when drinking in February, but it was avoidable by swallowing with the lower head. 1 ease of patient who was wound infection choked when drinking 8 months after the operation. His flap got a contracture. So with the stoma closed, he changed to pronounce by practicing the gullet. Conclusion Patients getting laryngeal carcinoma in the middle stage or the advanced stage receives a total laryngectomy-functional traeheoesophageal shunt for vocal rehabilitation, which can not only cure laryngeal carcinoma completely, but also restore the pronunciation function and retain the original phonetic features, including superior fidelity and fluent speech. The vocal effect lasts long. This kind of technique has fewer complications and satisfactory effects, which improves the quality of life of patients and so deserves a clinical generalization.