48例喉全切除气管断端膜样部食管吻合分流发音重建术长期疗效观察

A long-term observation of 48 cases of tracheoesophageal shunt phonation by the anastomosis of the membranous portion of the tracheal section with the anterior wall of esophagus after total laryngectomy

目的 研究喉全切除气管断端膜样部食管吻合分流发音重建术的长期疗效。方法 利用自制的随访表 ,对白求恩国际和平医院 48例患者做长期随访 ,其中喉癌行喉全切除发音重建术 46例 ,下咽癌行喉全切除发音重建术 2例。观察他们的发音和吞咽情况 ,并对手术并发症和生存率做了统计分析。结果 35例无喉者的言语水平接近正常喉言语水平 ,他们的最大发音时程较长、听距较远、言语可懂度高、较流利。 5例发音效果较差 ,但言语可懂度仍高。发音成功率 83 3% (4 0 / 48)。成功组中 ,40 0 %无喉言语者 (16 / 40 )有不影响正常进食的轻微误吸。另 8例不能发音 ,也没有误吸。气管瘘口、气管 食管分流口感染和咽瘘是影响发音重建成功的重要因素。生存率与单纯喉全切除术相当。结论 该术式一期完成 ,操作简单 ,发音成功率高 ,一些病例虽有轻微误吸 ,但不影响正常进食 。

Objective To study the long-term efficacy of tracheoesophageal (TE) shunt phonation by the anastomosis of the membranous portion of the tracheal section with the anterior wall of esophagus after total laryngectomy. Methods A questionnaire was designed to follow 48 patients with rehabilitated speech and swallow functions by the above approach. The qualities of phonation and speech, and the degree of aspiration evaluated, together with the survival rate and complications statistically analyzed. Results The speech level of 35 laryngectomees was similar to the normal laryngeal speech level. Thirty-five cases had longer maximal phonation time and hearing distance and higher speech intelligibility. Other 5 laryngectomees had less effective phonation, but higher speech intelligibility. The total effective rate was 83.3% (40/48). The speech fluency in 40 laryngectomees was not as good as that in the normal people. Forty percent laryngectomees(16/40)had slight liquid food aspiration which did not influence normal eating. Eight patients(8/48) failed to speak and no liquid aspiration occurred after the operation. The effective rate was affected obviously by neck infection and pharyngeal fistula formation. The survival rate was similar to those with single total laryngectomy. Conclusions The TE shunt phonation had the advantages of simple, one-stage operation and high success rate. Some laryngectomees had slight liquid food aspiration, but would not influence normal eating. So this TE shunt phonation operation may be useful during laryngeal surgery.