无假体气管食管分流无喉言语者误咽变化的观察

Observation of aspiration of laryngectomees in TE shunt speech without prosthesis

目的 :探讨无假体气管食管分流无喉言语者误咽的变化过程和影响因素。方法 :1 6例喉癌患者做了喉全切除无假体气管食管分流发音重建术。结果 :术后随访 1年 3个月 9年 6个月 ,死亡 3例 ,存活 1 3例。误咽转归 :由术后不漏呛转为微漏呛 7例 ,术后始终微漏呛 4例 ,由明显漏呛转为微漏呛 5例。误咽对发音的影响 :不漏呛时发音好 ,变为微漏呛时发音依然好 ;不漏呛时发音费时费力 ,变为微漏呛时发音渐好 ;始终微漏呛始终发音好 ;漏呛明显时发音不好 ,变为微漏呛时发音渐变好。无一例始终明显漏呛且始终发音不好的患者。结论 :该类术式能达到术后无误咽固然很好 ,若能做到术后发音好 ,虽有微呛、微漏 ,但仍能控制 ,影响进食轻微 ,也是成功的 ;术后放疗、感染和 (或 )咽瘘对误咽有明显影响 ;误咽的转归及对发音的影响是一个复杂的问题 。

Objective:To investigate the course of variation and influencing factors on aspiration in laryngectomees who underwent tracheoesophageal (TE) shunt speech without prosthesis.Method: Sixteen laryngeal cancer patients who were operated on for TE shunt voice rehabilitation without prosthesis after total laryngectomy. These laryngectomees experienced aspiration in different degrees after the operation. We designed a questionnaire to follow up alteration aspiration.Result: Of sixteen laryngectomees, the longest follow up time was nine years and six months, the shortest time was one year and three months, no one got lost in the follow up. In the follow up period, three laryngectomees died, other thirteen still survived. There were three basic aspiration variational courese: Seven patients changed from no leakage to slight leakage. Four patients remained slight leakage. Five patients changed from obvious leakage to slight leakage. Aspiration affect TE shunt speech in four different ways: No leakage, good voice;slight leakage, still good voice. No leakage,hard voice. If speak,take more time and use great effort. However,in some patients, if the slight leakage gradually appeared,the voice seemed to be better. If the slight leakage remained in the same degree,the patient got good voice all the time. Obvious leakage, hard voice.When leakage gradually became slight,voice grew better.There were no laryngectomees had the following situations:obvious leakage all the time, bad voice all the time.It was considered that radiation therapy induced aspiration in six laryngectomees.Neck infection and pharyngeal leak were believed to cause aspiration in five laryngectomees.Conclusion: Any surgical procedures with good voice,but no postoperative aspiration is the best choice in voice rehabilitation in laryngectomees.However,if some laryngectomees only have slight liquid food aspiration without interference with their normal diet;at the same time,those laryngectomees have high speech level,we consider the operation is acceptable.Definitely,radiation therapy,neck infection and (or) pharyngeal leak have some influence on aspiration.The variational course of aspiration and phonation change affected by aspiration are complex problems which need further investigation.