全喉切除术后Groningen发音钮发音重建术临床分析  

Prosthetic vocal rehabilitation with Groningen valve after total laryngectomy

作　　者：苏立众[1] 胡未鸣[1] 蒋学苑[1] 

机构地区：[1]浙江省人民医院耳鼻咽喉科,杭州310014

出　　处：《浙江医学》2010年第4期482-484,487,I0001,共5页Zhejiang Medical Journal

摘　　要：目的总结分析全喉切除术后应用Groningen发音钮进行发音重建的疗效，以期为临床提高手术成功率和进一步改善患者生活质量提供参考。方法回顾性分析近年来收治并施行全喉切除术后Groningen发音钮发音重建的14例患者的临床资料，讨论手术技巧和术后发音效果。结果所有患者手术均一次顺利完成。一期安装发音钮的9例患者2周后拆线即开始发音功能训练，其中8例能发出单音节，2个月内均能讲话自如；另1例患者2个月后逐渐适应练习，3个月后讲话自如，均达到Ⅰ级和Ⅱ级；二期安装发音钮的5例患者术后24h恢复进食，其中3例麻醉清醒后即能发单音节；1例发单音节较轻，训练2周后发音良好；1例不能发单音节，3个月后仍不能发单音节，并伴有吞咽异物不适感，经食管镜检查，发现食管面长满菌斑块样物，给予拔除，伤口自然愈合。结论全喉切除术后安装发音钮进行发音重建手术简便易行，发音效果好，术后并发症少，值得临床推广。Objective To evaluate prosthetic vocal rehabilitation applying Groningen valve after total laryngectomy. Methods Clinical data of 14 patients who underwent Groningen valve insertion after total laryngectomy were reviewed retrospectively; the surgical modalities and the results of vocal rehabilitation were discussed. Results The Groningen valves were inserted successfully in all patients. In 9 patients who underwent primary valve insertion at the time of total laryngectomy, the phonation training started 2 weeks after operation. Among these patients 8 were able to pronounce a single syllable immediately and spoke freely 2 month later; 1 patient spokek freely after 3 months of training. In 5 patients who had the second stage insertion, eating was recovered 24h after operation, 3 of which pronounced single syllable immediately. One patient failed to speak even after 3 months of training; esophagoscopy revealed the esophagus surface of valve was filled with plaque-like substance and the fistula was healed naturally after the valve removed. One case got a lower voice at beginning but returned to normal after two weeks training. Conclusion Groningen valve provides a highly acceptable means of vocal rehabilitation after total laryngectomy with the advantages of high success rates, immediate voice production, simple surgical procedure and low complications.

关 键 词：Groningen发音钮 发音重建 全喉切除术 

分 类 号：R767.91[医药卫生—耳鼻咽喉科]