全喉切除后I期粘膜瓣法气管食管发音重建术失败原因分析

Failure Causes Analysis of the Tracheoesophageal Voice Rehabilitation with I Mucosal Flap Method af- ter Total Laryngectomy

目的：探讨全喉切除后I期粘膜瓣法气管食管发音重建术的失败原因，进一步完善手术操作及适应证选择方法。方法：对1991年1月至2010年6月行全喉切除后I期粘膜瓣法气管食管发音重建术失败的9例患者的临床资料进行回顾性分析，特别是对其年龄、有无基础疾病、病变大小、手术方式、术后并发症的情况、术后放疗的剂量、术后心理因素以及术后有无进行发音康复训练等方面进行详细分析。结果：9例发音失败者中，2例不明原因瘘口闭锁，1例术后感染导致瘘口闭锁，1例术后感染导致气管食管瘘，1例年老体弱肺活量低，2例下咽组织切除较多、术后放疗剂量超过50GY，2例术后语言康复信心不足且未做规范的发音训练。结论：掌握好手术适应证和技巧，术后避免感染，重视术后个体化的综合治疗和规范的发音训练，可提高全喉切除后I期粘膜瓣法气管食管发音重建术治疗中晚期喉癌的疗效。

Objective：To investigate the failure causes of the trachcoesophageal voice rehabilitation with I mucosal flap method after total laryngectomy so as to improve the relevant methods and indications. Methods ： Clinical data of patients with the tracheoesophageal voice rehabilitation by I mucosal flap method ＇after total laryngectomy from January 1991 to June 2010 were analyzed retrospectively, especially the information a- bout the failed cases , including age, size of abnormality, methods of surgery, postoperative complications, postoperative radiation dose, postoperative psychological factors, and whether they had postoperative voice training. Results： Among the 9 failed cases, fistula was closed in 2 cases for unknown causes, 1 case of tracheo- esophageal fistula due to postoperative infection, 1 case with low vital capacity because of being old and weak, pharynx was resected too much and radiation dose was over 50 GY in 2 cases, and the voice training was not conducted in 2 cases because of the lack of confidence in recovering the ability to speak. Conclusions ： The tra- cheoesophageal voice rehabilitation with I mucosal flap method after total laryngectomy is a relatively ideal voice rehabilitation method if the indications and skills are mastered, the infection after operation is prevented and more attention is paid to comprehensive treatment and normative voice training.