喉全切除术后气管食管穿刺发声重建的远期效果  

Long-term results of tracheoesophageal puncture for voice restoration after total laryngectomy

作　　者：李清明[1] 张宝泉[1] 高志强[1] 彭培宏[1] 陈晓巍[1] 师秀珍[1] 谢洪[1] 伊海金[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院耳鼻咽喉头颈外科,北京100730

出　　处：《临床耳鼻咽喉科杂志》2005年第6期241-243,246,共4页Journal of Clinical Otorhinolaryngology

摘　　要：目的:探讨气管食管穿刺(TEP)安放BlomSinger发音管发声重建在喉全切除术后患者中的远期效果。方法:回顾性分析134例资料完整的喉全切除术后TEP安放BlomSinger发音管发声患者的临床资料。应用多维语音分析系统(MDVP)对其中18例发音管发声患者的声学参数进行检测分析。结果:所有病例均随访2～15年。1986～1989年12例中7例获得满意结果,成功率58.3%。1990年以后的122例中,114例效果满意,成功率93.4%,总成功率90.3%。MDVP检测的发音管发声主要声学参数值都远远偏离正常。常见并发症有瘘口肉芽增生,早期感染,气、食管瘘口过大出现漏液等。结论:TEP安放发音管,操作简单,并发症少,成功率高,质量好,远期效果稳定,是一种目前让无喉患者开口讲话较好的手术方法。咽、食管括约肌切开术能提高BlomSinger发音管发声重建的成功率。Objective:To evaluate the long-term results of tracheoesophageal puncture for Blom-Singer voice restoration after total laryngectomy and summarize our clinical experience of fifteen years.Method:From 1986 to 2001, one hundred and thirty four cases with Blom-Singer technique after total laryngectomy for voice restoration were analyzed retrospectively. MDVP of Kay Elemetrics was used to analyze the acoustic parameters of eighteen cases with Blom-Singer indwelling voice prosthesis for 2～14 years.Result:For all cases, the follow-up was two to fifteen years. From 1986 to 1989,seven of twelve cases were satisfied with their speech,the success rate was 58.3%.After the year of 1990, the success rate was 93.4%(114/122).The total success rate was 90.3%(121/134).The acoustic parameters of Blom-Singer indwelling voice prosthesis was far away from normal. The common complications included fistula granulations,infection, leakage.Conclusion:The procedure of tracheoesophageal puncture for voice restoration is relatively simple and has low complications,high phonation success,good phonation quality,and steady long-term results, which is the best way to make laryngectomeel to speak.Pharyngoesophageal sphincter myotomy can raise the success rate of voice restoration by Blom-Singer indwelling voice prosthesis.

关 键 词：喉切除术 气管食管穿刺 发音管 发声重建 

分 类 号：R767[医药卫生—耳鼻咽喉科]