Partial Horizontal Laryngectomy and Epiglottiplasty

In order to evaluate the availability of the lateral horizontal laryngectomy and anaplasty of epiglottis to treat some patients with specific supraglottic carcinomas and hypopharyngeal carcinomas, 17 cases of laryngeal and hypopharyngeal carcinomas were retrospectively analyzed, whose tumors were located at the lateral margin of epiglottis, aryepiglottic fold, medial wall of piriform fossa and were treated by the lateral horizontal laryngectomy and anaplasty of epiglottis. The results showed that all cases took food by mouth in postoperative 9-14 days and subjected to decannulation in postoperative 9-15 days. Three cases had postoperative hoarse voice. The free-disease survival rate of 3 years was 71.4 % in 14 cases followed up after the first surgical therapy, and the overall free-disease survival rate of 3 years was 85.7 % after the second surgical therapy. It was concluded that the manipulations of the lateral horizontal laryngectomy and epiglottiplasty were simple. It could alleviate the postoperative symptoms of aspiration and bucking remarkably and shorten their postoperative recovery time, yet does not lower the survival rate of patients if laryngocarcinoma or hypopharyngeal carcinoma cases were properly selected.

SUPRAGLOTTIC LARYNGECTOMY WITH OR WITHOUT ONEARYTENOID IN EPIGLOTTIC CARCINOMA (40 CASES REPORT)

Objective: To investigate the indications of supraglottic laryngectomy. Supraglottic laryngectomy with or without one arytenoid is a functional laryngectomy suitable for treatment of epiglottis squamous carcinoma. This procedure consists of resection of the thyroid cartilage, epiglottis and the entire preepiglottic space. Methods: Between 1990 and 1996, we used supraglottic laryngectomy to treat 40 patients with supraglottic carcinoma. The data were collected by a review of patient records and follow-up. The cancers were stages T1 (17 cases), T2 (17 cases) and T4 (6 cases) according to the 1987 UICC on cancer staging criteria. Results: 12 ipsilateral and one bilateral functional neck dissection were operated simultaneously. Of which 7 patients had metastasis in lymph nodes. No patient died postoperatively. Only 8 (20%) had slight aspiration before the 20th day. All patients had decannulated. 29 cases received radiotherapy and chemotherapy. A follow-up analysis showed survived rate of 74% at 3 years. Conclusion: We propose supraglottic laryngectomy for the surgical treatment of early supraglottic carcinomas, which could acquire almost normal laryngeal function.

Reorganization characteristics of speech cortex during speech restoration following total laryngectomy A functional magnetic resonance imaging follow-up

During speech restoration following laryngectomy, language-related cortical areas develop connections with new primary motor neurons. The present study followed up 18 patients after total resection of laryngeal carcinoma. According to an evaluation of pronunciation, patients were assigned to three groups： poor, moderate and good pronunciation. Functional magnetic resonance imaging revealed significant increases in the number of activated voxels and the intensity of activation changes in the left middle frontal gyrus, left precentral gyrus, left postcentral gyrus, left supplementary motor area, left anterior cingulate gyrus and right fusiform gyrus between the moderate pronunciation group compared with the poor and good pronunciation groups. We propose that these brain regions play an important role in the progress of speech restoration, and improvements in pronunciation learning for patients following laryngectomy. However, during the later period of speech restoration, the number of activated voxels and intensity changes in these regions decreased to the level of healthy controls, indicating that the learning and instruction effects weakened once patients had mastered pronunciation techniques

Reconstruction of laryngeal function in subtotal laryngectomy with preservation of monoarytenoid cartilage

Objective: To evaluate subtotal laryngectomy with preservation of monoarytenoid cartilage to re-construct laryngeal function in the treatment of advanced laryngeal cancer. Methods: We retrospectively re-viewed 48 patients with advanced laryngeal cancer (T3 or T4 on the primary site) treated by subtotal laryngec-tomy with preservation of monoarytenoid cartilage to reconstruct laryngeal function. Eighteen of them under-went neck dissection. Ipsilateral recurrent laryngeal nerve was preserved during this surgery. The cricoid cartilage was anastomosed to hypopharynx accordingly. Results: The overall 3- and 5-year survival rates were 81.25% (39/45) and 66% 67% (32/48), respectively. All patients had good phonation and swallowing function after surgery. Decannulation rate was 93. 75%. Conclusion: Subtotal laryngectomy with preserva-tion of monoarytenoid cartilage is satisfactory for treatment of elected advanced laryngeal cancers. The effect of this surgery is more satisfactory than that of the near-total laryngectomy (Pearson''s technic).

Investigation of QOL after Laryngectomy Using the UW-QOL Questionnaire with Chinese Patients

OBJECTIVE To assess the postoperative QOL(Quality of Life) of Chinese laryngeal cancer patients who have undergone a partial or total laryngec-tomy, and to analyze their prognostic factors, as well as to assess the feasibility of using the University of Washington Quality of Life (UW-QOL) questionnaire in QOL studies of laryngeal cancer patients, METHODS Using the UW-QOL questionnaire, a survey was conducted in patients treated by a partial or total laryngectomy for laryngeal cancer. RESULTS Questionnaires were sent to 142 patients who were disease-free for more than half a year after surgery. Replies were received from 130 patients (91% response rate) with 118 patients completing the questionnaire. These patients were divided into 2 groups: a partial-laryngectomy group (n=81; excluding cordectomy) and a total -laryngectomy group (n=37). The composite QOL scores of the partial-laryngectomy group (692.3±127.9) were higher than those of total-laryngectomy group (636.4±140.0), showing a statistically significant difference (P<0.05). The partial-laryngectomy group (74.3±23.8; 80.9±20.3) was better than the total-laryngectomy group (40.3±25.8; 69.6±27.1) in speech and appearance (P<0.001; P<0.05); but the total-laryngectomy group (92.6±13.0) was superior to the partial-laryngectomy group (83.0±20.5) in pain (P< 0.01). Six factors including cancer stage, operative modality, complications, postoperative radiotherapy or chemotherapy, living partners and chronic disease before or after operation were related to postlaryngecto-my QOL. CONCLUSION Partial laryngectomy is superior to total laryngectomy in speech, appearance and overall QOL. Besides operative modality, cancer stage, complications, postoperative radiotherapy or chemotherapy, living partners and chronic diseases before or after operation are factors influencing postlaryngectomy QOL. As a whole, the UW-QOL questionnaire is a good instrument for studying QOL of laryngeal cancer patients in China, and it can be used to explore the QOL outcomes obtained from different reconstructive techniques.

Surgery model investigations on reconstruction of vocal function after total laryngectomy

Objective To establish a surgery model that can prevent stenosis of trachea stoma and reconstruct vocal function by stoma with tracheal esophagus flaps.Methods Vocal reconstruction operations of 29 laryngectomized patients from 1994 were performed with the first stage mucosal valvular shunt of tracheo esophagus and Griffith tracheostoma enlargement method.Results In these 29 cases,26 cases achieved voice reconstruction.In them,there were 2 cases needed cannulation for 3 months.The others didn’t need cannulation and no stricture was found after followed them up for more than one year.Conclusion The vocal reconstruction operations with Griffith tracheostoma enlargement method and first stage mucosal valvular shunt of tracheo esophagus is a good method to treat laryngeal carcinoma and resume laryngeal function.

A Qualitative Study on Experiences of Patients with Esophageal Speech Training after Total Laryngectomy

Background: Patients who had total laryngectomy not only have a pressure from the possible diagnosis of laryngeal cancer, but also suffer from unspeakable misery. To relieve the suffering, some patients choose esophageal speech training. However, most of the current researches focus solely on the results of the training with the negligence of the patients’ mental health and their life experience during the training. A qualitative research is highly sensitive to patients’ subjective feelings, and thus able to capture their subtle emotional changes. Objective: To explore deeply patients’ real experiences of esophageal speech training after total laryngectomy and reveal the public their training experience of the unique and special group. Methods: In May 2018, researchers conducted a two-month field observation on and in-depth interviews with 15 patients who were on esophageal speech training after total laryngectomy in the esophageal speech training room of the Eye and ENT Hospital of Fudan University. The research applied phenomenological research method and Colaizzi Data Analysis. Results: The data analysis indicated four main themes: changes of mindset;showing positive attitudes and behaviors in training;shift in social relations;and arduous training process. Conclusion: The study has the finding that patients on esophageal speech training had negative emotions in the early stage of the training and dissatisfaction with its teaching. The repercussion of the surgery brought them changes of social relations, social bias and prejudice ensued. It is, therefore, urgent and crucial to give the speech trainees psychological counseling in the early stage to improve their qualities of life, to mobilize social support to incentivize their training, to optimize esophageal speech training teaching, and to regulate the management of the esophageal speech training environment.

Comparison of the Clinical Outcomes of Early Enteral Nutrition Versus Convenience Diet by Tube Feeding Following Laryngectomy in Chinese Patients

The purpose of the present study was to evaluate the efficiency of early enteral nutritional support in patients undergoing laryngectomy. We retrospectively reviewed and analyzed 329 laryngeal cancer patients who underwent total or partial laryngectomy from November 2003 to July 2013 in our hospital. Of those patients, 278 were given enteral nutrition (EN group) with elemental formulations through a nasogastric tube beginning within 24 hours after the surgery, while 51 chose not to receive the elemental formulations and were on a homogenate diet (convenience diet group, CD group), which was also given through a nasogastric tube. The clinical outcomes were compared between the two groups. Thirteen patients in the EN group (13/278, 4.68%) and six patients in the CD group (6/51, 11.76%) developed fistulas. The difference was statistically significant (P < 0.046). The differences in the post-surgical infection rate, average length of hospitalization and other clinical indicators between the two groups were not statistically significant. In conclusion, early enteral nutrition should be recommended in patients undergoing laryngectomy, and convenience diet is not as effective as the commercial formulation in reducing the risk of fistula formation.

Linear Stapler in Total Laryngectomy

Introduction: Stapler application for pharyngeal closure after total laryngectomy allows rapid watertight closure. We intend to report the experience of the Portuguese Oncology Institute of Lisbon, Francisco Gentil (IPOLFG). Material and Methods: Retrospective study of patients submitted to total laryngectomy using linear stapler device treated in IPOLFG from 2005 to 2010. Results: 108 patients were studied. The majority of patients were male, aged from 60 to 69 years old, and had smoking and alcohol habits. The average length of hospital stay was 13.1 days. Post-operative complications occurred as follows: wound infection in 6.5%, cervical hematoma in 4.6% and pharyngocutaneous fistula in 11.1% of cases. Conclusions: The mechanical suture of the pharynx in total laryngectomy is a simple and quick method. It does not increase the incidence of post-operative complications. It seems to be a very safe method, as long as its limits regarding the location and extent of tumour are respected.

下咽癌全喉切除术后咽瘘发生的危险因素分析

目的探讨下咽癌全喉切除术后咽瘘发生的危险因素。方法回顾性分析2009年1月至2019年12月南京医科大学附属肿瘤医院收治的89例下咽癌全喉切除患者的临床资料。根据术后是否发生咽瘘分为咽瘘组和无咽瘘组,分析患者相关、疾病相关及治疗相关的咽瘘发生的危险因素。结果89例患者中有20例术后出现咽瘘,69例未出现咽瘘,总体咽瘘发生率为22.5%。单因素分析显示,咽瘘组有糖尿病史(P=0.031)、术前行放化疗(P=0.021)、术前低白蛋白血症(P=0.008)、术后低白蛋白血症(P=0.002)及采用皮瓣修复(P=0.034)的患者占比高于无咽瘘组。多因素logistic回归分析显示,术后白蛋白水平是咽瘘发生的独立保护因素(OR=0.174,95%CI 0.048~0.626,P=0.007)。结论有糖尿病、围手术期低白蛋白血症或术前接受放化疗的下咽癌患者全喉切除术后更易发生咽瘘。

正念减压联合分阶段康复护理对喉癌喉部分切除术后患者吞咽功能及负性情绪的影响

目的考察正念减压联合分阶段康复护理对喉癌喉部分切除术后患者吞咽功能及负性情绪的影响。方法90例行喉癌喉部分切除术患者,随机分为对照组和观察组,各45例。对照组给予常规护理干预方法,观察组给予正念减压联合分阶段康复护理方法。比较两组患者吞咽功能、心理状态、癌因性疲乏和生活质量、并发症发生情况。结果干预后8周,两组标准吞咽功能评价量表(SSA)评分均低于干预前和干预后4周,中文版安德森吞咽困难量表(MDADI)评分均高于干预前和干预后4周,且干预后4周,两组SSA评分均低于干预前,MDADI评分均高于干预前(P<0.05)。干预后4、8周,观察组SSA评分分别为(10.41±1.88)、(8.72±1.25)分,均低于同期对照组的(11.51±1.67)、(9.63±1.19)分,MDADI评分分别为(65.41±5.33)、(75.82±5.13)分,均高于对照组的(62.81±5.67)、(73.42±5.50)分(P<0.05)。干预后8周,两组抑郁自评量表(SDS)、焦虑自评量表(SAS)评分均低于干预前和干预后4周,且干预后4周,两组SAS、SDS评分均低于干预前(P<0.05)。干预后4、8周观察组SAS、SDS评分均低于同期对照组(P<0.05)。干预后8周,两组Piper疲乏修订量表(PFS)均低于干预前和干预后4周,头颈部癌生命质量测定量表(QLICP-HN)评分均高于干预前和干预后4周,且干预后4周,两组PFS评分均低于干预前,QLICP-HN评分均高于干预前(P<0.05)。干预后4、8周,观察组PFS评分均低于同期对照组,QLICP-HN评分均高于同期对照组(P<0.05)。观察组并发症发生率6.67%低于对照组的22.22%(P<0.05)。结论正念减压联合分阶段康复护理能够有效改善喉癌喉部分切除术后患者的吞咽功能和负性情绪,缓解癌因性疲乏,提高生活质量,降低并发症发生情况。

食管发音康复失败原因分析及对策研究进展

对目前国内外全喉切除术后接受食管发音训练的病人为研究对象,食管发音训练的影响因素及失败原因进行综述,并提出相应的护理对策,以期为国内开展相关研究提供参考。

基于同伴教育的食管发音培训在全喉切除术后患者中的应用

目的评价基于同伴教育的食管发音培训对全喉切除术后患者食管发音质量及心理韧性的影响。方法选择在湖北省肿瘤医院行全喉切除手术后的患者作为研究对象。以2021年1-6月行手术治疗的24例患者作为对照组,以2021年7-12月行手术治疗的25例患者作为观察组。两组患者均分别接受1次食管发音集训课程(术后6个月后)及2次巩固课程(术后9个月及12个月后),同时辅以线上指导。对照组患者的食管发音指导及线上答疑由头颈外科护士进行,观察组则由经招募及培训的5名同伴教育者实施。比较两组患者术后短期及中长期食管发音质量以及心理韧性(CD-RISC)水平。结果观察组患者短期及中长期食管发音质量均优于对照组(P<0.05)。且集训课程及第2次巩固课程后,观察组患者的CD‑RISC得分均高于对照组(P<0.05)。结论基于同伴教育的食管发音培训可以帮助患者重建发声功能,促进其言语康复及心理状态调适,有助于提高患者的心理韧性水平。

T_(1b)声门型喉癌的治疗现状

声门型喉癌治疗方式的选择决定着患者的生存质量和预后,T_(1b)声门型喉癌有多种治疗方式,各方式有不同的优势与不足,本文综述T_(1b)声门型喉癌的治疗现状。

地佐辛在喉癌术后静脉自控镇痛中应用的前瞻性随机对照研究

目的探讨不同剂量的地佐辛相比舒芬太尼在喉癌术后镇痛效果的差异。方法采用随机对照研究,将2022年2月至2023年1月择期行部分喉手术的129名患者随机分为地佐辛0.5 mg/kg组(D1组)、地佐辛0.6 mg/kg组(D2组)和舒芬太尼2μg/kg组(S组)。比较3组24 h镇痛泵用量,术后6、12、24和48 h的视觉模拟评分(visual analogue scale,VAS)和48 h自控镇痛(patient-controlled intravenous analgesia,PCIA)按压总次数,并记录两者术后的不良反应(恶心、呕吐、头晕、尿潴留和呼吸抑制)发生率。结果3组24 h镇痛泵用量无差异,术后6 h D1组VAS评分高于S组(P<0.05),12、24和48 h 3组VAS评分之间差异无统计学意义。3组在总按压次数和术后不良反应之间无明显差异。结论与应用舒芬太尼相比,0.6 mg/kg地佐辛可提供相同程度的镇痛效果,但并未发现可降低不良反应等优势。

线上课程联合回授法在喉切除患者及照顾者中的应用效果

目的·探讨线上课程联合回授法在喉切除患者及照顾者中的应用效果。方法·采用便利抽样法,选取2022年7月—2023年6月在上海市长海医院耳鼻咽喉科收治的喉切除患者及其家庭照顾者,运用随机数字表分为对照组和观察组,分别安置在2个病区进行干预。收集2组患者及照顾者的一般资料。对照组于入院后线下观看科室录制的喉癌相关知识讲解以及气道造口护理、吸痰和鼻饲等操作标准流程视频;视频分4次观看,每周1次,30 min/次。观察组入院后在线上自行观看相同的视频(8个课程),同时护理人员应用回授法进行每周1次的健康教育,每次巩固2个课程,45 min/次,共4次。分别于基线(第1周)、出院前(第4周)、出院后1个月(第8周)采用照顾者准备度量表(Caregiver Preparedness Scale,CPS)、家庭照顾者照顾能力量表(Family Caregiver Task Inventory,FCTI)、中国头颈癌患者生命质量测定量表(Quality of Life Instruments for Cancer Patients-Head and Neck Cancer,QLICP-HN),以及出院后居家护理期间不良事件发生率进行效果评价。结果·共纳入120对患者及其照顾者,对照组和观察组各60对,因各种原因2组各剔除5对,最终每组入选55对。2组患者和照顾者的一般资料、基线时患者的QLICP-HN得分,以及照顾者的CPS和FCTI得分,差异均无统计学意义(均P>0.05)。出院前和出院后1个月,观察组照顾者的CPS得分和患者的QLICP-HN得分均显著高于对照组,FCTI得分显著低于对照组(该量表得分越低表示照顾能力越强),差异均具有统计学意义(均P<0.05)。观察组在出院后1个月内居家护理不良事件发生率低于对照组(5.5%vs 29.1%),差异具有统计学意义(P<0.05)。结论·线上课程联合回授法有助于提高喉切除术后患者的家庭照顾者的照顾准备度及照顾能力,提高患者的生活质量,降低居家护理期间不良事件发生率。

全喉切除术发声重建后嗓音主客观评估研究进展

全喉切除术是治疗晚期喉癌的主要策略,该手术会改变患者生活,对嗓音产生深远影响。术后患者不可避免会失去喉这一发声器官,从而导致失声。目前,针对无喉患者的发声重建从以下3种方式进行,食管言语、气管食道言语和电子喉言语。嗓音评估一般采用感知声音量表、自评量表或问卷以及声学仪器测量。本文针对全喉切除术后嗓音评估进行追溯与总结,关注目前主流的评估方式,探究全喉切除术后的嗓音质量。

全喉切除术后嗓音功能康复

恢复全喉切除术后患者的发音功能对医师来说仍然是一个巨大挑战。多年来,本团队一直致力于全喉切除术后发音功能重建工作,并取得了一定的成果。本文旨在介绍我们应用颈前带状肌、舌骨下肌皮瓣和颈前皮瓣进行全喉切除术后发音功能重建的方法和效果,并综述其他发音方法的优劣,为临床医师探索和解决这一难题提供参考。

喉癌部分喉切除术后患者早期经口进食体验的质性研究

目的了解喉癌部分喉切除术后患者早期经口进食的真实体验,为构建个性化的饮食干预方案提供参考。方法采用目的抽样法,选取2023年6-12月在山东省第二人民医院行部分喉切除术的13例喉癌患者进行半结构式访谈,运用Colaizzi 7步分析法进行资料分析。结果共提炼出3个主题:经口进食的困境(不良的进食体验、未掌握/不了解经口进食的技巧、经口进食的欲望下降、负性心理严重)、患者渴望理解与支持(渴望家人的理解、渴望同伴的指导、渴望医务人员的专业指导)、经口进食的促进因素(家人的关爱、医务人员的鼓励、患者康复的信念)。结论喉癌部分喉切除术后患者早期经口进食期间存在生理和心理等多方面的问题,医护人员应联合患者家庭成员、同伴帮助患者改善经口进食体验,促进患者早日康复。

窄带成像喉镜在喉癌切除术后随访评估中的应用效果分析

目的分析窄带成像喉镜在喉癌切除术后随访评估中的应用价值。方法选取我院2019年10月~2021年10月行喉切除术治疗的84例喉癌患者进行为期1年的术后随访,定期行WLE及NBI模式电子喉镜检查,分析两种光源检查模式在术后随访中的应用价值。结果本组接受喉癌切除术治疗患者随访过程中,病理活检结果显示术后局部复发30例,WLE模式检查显示术后局部复发23例,NBI模式检查显示术后局部复发29例,NBI模式评估喉癌切除术后随访结果的敏感度、准确度分为90.00%、94.05%,显著高于WLE模式的66.67%、84.52%(P<0.05)。结论NBI模式在喉癌切除术后随访评估中有着良好的应用价值,可将NBI模式作为喉癌切除术后随访的常规检查手段。