大连地区全喉切除术后发声方式的调查与评估

Investigation and evaluation of sound patterns after total laryngectomy in Dalian

目的调查及评估大连地区全喉切除术后患者的辅助发声方式,为选择最佳辅助发声方式提供参考依据。方法随访73例大连地区全喉切除术后患者,并根据术后发声方式分为气动式人工喉组,电子喉组及食管发声组。由耳鼻喉科医师主观评估嗓音的清晰度,连贯度,响度及音色;使用声学分析仪器客观评估嗓音的基频,基频微扰,声强,最长发声时间及一口气音节数。结果 (1)大连地区全喉切除术后患者应用气动式人工喉组27例,电子喉组14例,食管发声组6例。(2)主观评价中,气动式人工喉组在言语清晰程度、音色方面分值高于电子喉组,差异有显著性意义(P<0.05);气动式人工喉组在言语连贯程度、响度及音色方面的分值也高于食管发声组(P<0.05)。客观评价中,气动式人工喉组的基频、声强、基频微扰、最长发声时间及一口气音节数均优于食管发声组(P<0.05);气动式人工喉组与电子喉组在基频微扰的差异也有显著性意义(P<0.05)。结论应用气动式人工喉发声流畅、语言连贯、声量大、音色接近正常,基本能满足日常会话交流需要,可以作为全喉切除术后辅助发声的首选。

Objective To investigation and evaluation the auxiliary voice way of larynx and hypopharynx cancer patients after total laryngectomy in dalian area. To provide a reference for choosing the best way to assist sound. Methods Follow- up of 73 cases of dalian laryngeal cancer and hypopharynx cancer patients after total laryngectomy. According to the postoperative voice way is divided into pneumatic artificial larynx,electronic larynx group and esophageal voice group. Subjective assessment the voice clarity,coherence,loudness and voice quality by the otolaryngology doctor and objective evaluation by the use of acoustic analysis instrument. Results（ 1） Patients after total laryngectomy in Dalian application pneumatic artificial larynx 20 patients; electronic larynx group of 12 cases; 6 cases of esophageal vocal group.（ 2） In subjective assessment,pneumatic artificial larynx and electronic larynx group have significant difference in clarity and tone（ P〈 0. 05）. Pneumatic artificial larynx with esophageal voice group in consistency,loudness,timbre comparison difference has significant meaning（ P〈 0. 05）. In objective assessment,pneumatic artificial larynx with esophageal voice group in fundamental frequency,sound intensity,the longest time and relief the difference of the number of syllables is significant meaning（ P 〈0. 05）. Pneumatic artificial larynx and electronic larynx group in fundamental frequency perturbation difference has significant meaning（ P 〈0. 05）. Conclusion The voice of pneumatic artificial larynx vocal is fluent and consistent,the sound is load,the timbre is close to normal,it can meet the basic needs andbe used as adjuvant of choice for total laryngectomy audible.