喉全切除后气管造口及发音管的应用研究

Studies on treacheostomal formation and voice prosthesis after total laryngectomy

目的探讨喉全切除术后建造不狭窄的气管造口同时防止造口处“碗状”塌陷形成的术式。方法回顾分析１９９６年以来我科应用ＢｌｏｍＳｉｎｇｅｒ技术行喉全切除后重建气管食管音患者２５例，采用五种方法行气管造口术，其中６例在一期手术中采用颈前“Ｕ”形切口＋切断双侧胸锁乳突肌胸骨端＋Ｇｒｉｆｉｔｈ气管造口扩大术（综合法），并安装常植式发音管和呼吸瓣膜器。结果２５例中２３例成功发音，成功率９２％，气管造口方法中皮肤与气管环直接缝合者７例，Ｍｙｅｒｓ法３例，Ｇｒｉｆｉｔｈ法６例，道士名仁法３例，术后均需戴管半年以上并出现不同程度的造口狭窄及“碗状”塌陷形成。采用综合法行气管造口术６例术后不需戴管，随访半年以上造口基本不狭窄，且无“碗状”塌陷形成。结论采用综合法行气管造口术方便了发音管及呼吸瓣膜器的安装、护理以及更换；常植式发音管的音质最好；呼吸瓣膜器的应用不需要患者用手指堵住气管造口进行发音。

Objective To establish a tracheostomy model with no stricture and “bowl shaped” collapse. Methods Twenty five cases were reconstructed with Blom Singer technique after total laryngectomy for tracheoesophageal voice in our department since 1996. Tracheostoma was done with 5 kinds of methods. In 6 cases ,anterior cervical U shaped incision + division of sternal attachments of bilateral sternomastoid muscles + Griffith tracheostoma enlargement (combination method ) were used in the primary operation, and the third generation of indwelling prosthesis and tracheostomal valve were installed. Results In these 25 cases, 23 could speak freely. The successful rate was 92%. In tracheostoma operation, there were 7 cases with their skin sutured directly to tracheal rings, 3 cases with Myers method, 6 cases with Griffith method, 3 cases with method. All of them needed cannulation for more than 6 months and had stricture of tracheostoma and “ bowl shaped” collapse of various degrees. But those underwent “combination method” needed no cannulation and no stricture and bowl shaped collapse was found during 6 mouths’ follow up. Conclusion The combination method of tracheostomy makes the installation, postoperative care and replacement of prosthesis and tracheostomal valve easy and the indwelling prosthesis has the best tone quality. The use of tracheostomal valve effectively makes the patient's hand free during speaking.