纤维喉镜检查对喉次全切除咽环吻合术后新喉口的整复作用

Fibroendoscopy of Larynx After Subtotal Laryngectomy and Cricopharygeal Anastomosis

为寻求喉次全切除咽环吻合术后，喉的呼吸、吞咽、发声功能恢复的相关因素，对５７例喉次全切除咽环吻合术后不同时期的患者进行１１５次纤维喉镜检查，经摄像拍照对比观察，发现凡新喉口前后径或左右径为７ｍｍ以上，双侧人工披裂占新喉口后缘约１／５范围，梨状窝形态正常的患者均可顺利拔除气管套管，发音虽沙哑、但清晰响亮可懂度好，且无吞咽困难。过多保留喉粘膜，易形成新喉口活瓣样阻塞造成拔管困难；而保留太少，易致误吸、影响发音。纤维喉镜检查对拔管困难的患者，在新喉口修整术的适应证及手术范围方面有一定指导意义，能提高拔管率、完善喉次全切除术后咽环吻合。

In an attempt to evaluate the functions of the larynx after subtotal laryngeal and cricopharyngeal anastomosis,115 fibrendoscopies were performed and results videotaped in 57 cases.It appears that in order for decannulation,the artificial arytenoid must take up more than one fifth of the opening of the cricoparyngeal anastomosis with its "reconstructed pyriform fossa".This also provided well articalated phonation,though hoarse,without aphagia.Preservation of too much local mucosa usually made decannulation difficult while insufficient preservation led to aspiration and unsatisfactory phonation.Fibroendoscopy is helpful in assessing post surgery artificial hypopharyngo larynx and may help improve surgical technigues.