全喉切除患者咽食管段长度与假体发音的关系  

Correlation between Length of the Pharyngoesophageal Segment and Speech by Voice Prosthesis in Laryngectomized Patients

作　　者：周智永 马瑞霞[2] 侯丽[2] 刘静[2] 高建中[2] ZHOU Zhi-yong;MA Rui-xia;HOU Li;LIU Jing;GAO Jian-zhong(Dept.of Otorhinolaryngology,Ningxia People's Hospital,Yinchuan 750021;Dept.of Otorhinolaryngology Head Neck Surgery of General Hospital of Ningxia Medical University,Yinchuan 750004)

机构地区：[1]宁夏人民医院耳鼻咽喉科,银川750021 [2]宁夏医科大学总医院耳鼻咽喉头颈外科,银川750004

出　　处：《宁夏医科大学学报》2012年第8期802-804,封4,共4页Journal of Ningxia Medical University

基　　金：国家自然科学基金(30973296)

摘　　要：目的通过多排螺旋CT测量全喉切除患者咽食管段(PES)长度,探讨发音假体位置与发音关系。方法随机抽取全喉切除患者20例(实验组),其他疾病的患者40例(对照组)。通过多排螺旋CT测量两组咽食管段长度,并将实验组前期检测的前鼻孔至食管入口及至发音管平面距离等数据进行综合分析,算出发音管距离PES下界的距离。结果两组男性和女性PES长度差异均无统计学意义(P>0.05);实验组PES长于对照组(P<0.01)。失音组和发音组发音管距离PES下界的距离分别是1cm和2cm。将气流引入PES入口下1cm处,失音组均能发音。结论发音组利用2cm环咽肌高压力迫使气流向上冲击咽食管段入口黏膜发音;失音组则相反,发音管距离PES的下界短,气流易进入食管、胃内而失音。Objective To measure length of the pharyngoesophageal segment of laryngectomized patients by multi-slice spiral CT,and to explore the relationship between the position of voice prosthesis and voice.Methods All subjects were chosen from the patients with laryngeal carcinoma who had received total laryngectomy in department of Otorhinolaryngology head neck surgery of general Hospital of Ningxia Medical University from March 1994 to June 2008.20 patients were randomly chosed as the experimental group;40 patients with other diseases who had checked multi-slice spiral CT at general hospital of Ningxia medical university since january 2007 to march 2009 were randomly selected as the control group.The length of the pharyngoesophageal segment was measured by multi-slice spiral CT in both groups.The distance of between anterior naris to voice prosthesis measured in earlier stage study was utilized in order to calculate the distance of between voice prosthesis and below boundary of pharyngoesophageal segment.Results Length of the pharyngoesophageal segment was significant difference between the experimental group and the contrast group(P<0.01).Length of the pharyngoesophageal segment was not significant difference between male and female in both groups(P>0.05).The distance of between voice prosthesis and below boundary of pharyngoesophageal segment was 1cm in the nonspeech group and 2cm in the speech group.Airflow was led in the position of 1cm below the pharyngoesophageal segment entrance,all patients in the nonspeech group could pronounce.Conclusion Airflow was obstructed downward by high pressure of 2cm which is width of the cricopharyngeus muscle and upward shocked mucous membrane in entrance of the pharyngoesophageal segment to pronounce in the speech group.On the contrary,airflow was easy to enter esophagus and stomach and could not pronounce because the distance of between voice prosthesis and below boundary of pharyngoesophageal segment was short in the nonspeech group.

关 键 词：喉全切除术 多排螺旋CT 咽食管段 发音重建 

分 类 号：R473.73[医药卫生—护理学]