喉全切除气管食管分路发音重建的防误咽术

Tracheoesophageal shunt for voice reconstruction after total laryngectomy to prevent from deglutition disorders

目的 观察喉全切除气、食管分路发音重建防误咽术的效果。方法 1991年 10月～2 0 0 1年 5月对 79例T3、T4喉癌患者喉全切除术中行气、食管分路发音重建防误咽术 ,在食管前壁和气管后壁做一个长约 0 8～ 1 2cm发声口 ,同时保留环状软骨宽度 1 2cm ,长度 2 0cm做成软骨黏膜瓣防误咽檐 ,气管膜部向前外与皮肤缝合 ,做成防误咽斜度。结果 79例患者中有 71例患者获得良好发声 ,71例患者中有 6 5例防误咽成功 ,6例失败。 6 5例患者随访 1年以上 ,均无误呛。 79例患者术后T3、T4期 3年生存率分别是 6 6 7% (14 / 2 1)和 6 4 9% (2 4 / 37)。T3、T4期 5年生存率分别是 6 / 10和5 0 0 % (10 / 2 0 )。结论 气、食管分路发音重建防误咽术能有效地防止误咽。

Objective To observe the effect of tracheoesophageal shunt on voice reconstruction after total laryngectomy. Methods Seventy-nine patients with laryngeal cancer of T3 and T4 stages were conducted an operation of tracheoesophageal shunt after total laryngectomy. The vertical voiced slit with a length of 0.8～0.12 cm was made between the posterior wall of trachea and the frontal wall of esophagus, while the cricoid cartilage flap with the length of 2.0 cm and width of 1.2 cm was reserved to form cartilage mucosa flap as an edge to prevent deglutition disorders. Finally, membranous part of trachea was sutured together with the neck skin as an inclination edge. Results In this series,71of 79 patients kept good voice function, and 65 of 71 patients avoided deglutition disorders, but other patients failed to do so. The 3-year survival rate was 66.7% (14/21, for stage T3) and 64.9% (24/37, for stage T4), respectively. The 5-year survival rate was 6/10 (for stage T3) and 50.0% (10/20, for stage T4), respectively. Conclusion The operation of tracheoesophageal shunt is advantageous to prevent deglutition disorders as well as to restore the voice function of larynx.