喉全切除发音重建术的探讨

Recraeting artificial speech after total laryngectomy

目的 分析２４ 例全喉切除瓣膜式气管食管分流发音重建术的临床资料帮助患者恢复发音功能。方法 对１９８２～１９９８ 年作喉全切除瓣膜式气管食管分流发音重建术２４ 例，采用全喉切除后，在气管后壁距断端约１ｃｍ 处，切透气管食管粘膜全层，缝合三角形粘膜组织瓣，形成帽状，发声时以此阻挡气流，使空气经气管食管瘘孔冲入食管内。结果 ２２ 例发音功能良好，２ 例因咽瘘缝合瘘口改食管发音，收到满意效果。结论 无喉瓣膜式气管食管分流发音，吐字清晰，语言连贯性好，保持了患者原来语言特点，而且有效防止了术后唾液漏，值得在临床中推广。

Objectives To disouss the clinical characteristics of the recreating artificial speech with tracheoesophageal parting phonation in prosthetic valve after total laryngectomy and improve the speech of patients with this technique.Methods The artificial speech of 24 cases were created with tracheoesophageal parting phonation in prosthetic valve after total laryngectomy from 1982～1998.There were male 22 cases,female 2 cases;age 37～71,mean 58;clinical stage Ⅱ 4 cases,stage Ⅲ 15 cases,stageⅣ 5 cases.The technique of operation dealed mainly with,after total laryngectomy,cutting through the total layer of tracheoesophageal mucosa in 1 cmaway from the margin of the trochea posterior wall,stitching and forming a triagle mucous valve wich looked like a cap and obstructed air in speech to make air to go into esophagus through trocheosophageal fistula.Results 22 cases showed the good function of speech and 2 cases did the esophageal speech resulting from pharyn fistula and stitching fistula.Conclusions The tracheoesphageal parting phonation in prosthetic valve after laryngectomy indicatd speeching clearly and coherenly,keeping the character of primary speech and preventing the qaliva fistula after operation.Therefore,it is benificial to be recommended in clinic