全喉切除术后Blom-Singer法发音效果相关因素的检测观察  

Detectation and observation of related factors on pronunciation effect after total laryngectomy with Blom Stinger technique

作　　者：郑珺 李正廷[2] 

机构地区：[1]广州市肿瘤医院头颈科,510095 [2]北京首都医科大学附属红十字朝阳医院耳鼻咽喉科

出　　处：《中华物理医学与康复杂志》2000年第4期243-245,共3页Chinese Journal of Physical Medicine and Rehabilitation

摘　　要：目的　为寻找目前国际上最为推崇的全喉切除术后Blom Singer法复音患者发音效果存在差异的原因 ,使无喉者言语功能最大限度地接近正常人。方法　对 18例无喉者Blom Singer法发音重建术后的患者用特制的毫米水柱压力表连接气管造口 ,测定使用 16Fr或 2 0Fr发音管发音时的气管食管气流压力 ,结合运用喉内窥镜、监视器、录像机、彩打装置及频闪喉镜观察研究新喉闪光和平光下的动、静态特征 ,同时对每位患者进行了发音效果评定 (声时、数数、可听距离、可懂度、语句连贯性 )并作同步录音。结果　①测得Blom Singer法复音的无喉者最佳发音时气管食管平均压力为 45mmH2 O ( 1mmH2 O =9.80 665Pa) ;②发“依”音时平光下新喉形态以三角形和梭形为主 ,动态闪光下新喉形态振动好的酷似声带 ,有双重体振动 ,振动越好 ,发音效果越佳 ;③使用 16Fr或 2 0Fr发音管的患者其发音效果、新声门开口形态无明显差异。结论　发音效果好坏取决于气管食管适当的气流压力和新喉振源体的振动 ,而不是发音管型号大小及新声门开口的形态。Objective Blom singer voice reconstructoin technique after total laryngectomy has been canonized to be the best one all over the world for the time being.The pronunciation effect of patients who have undergone this technique is still different.The purpose is to find out the cause of such difference to promote alaryngeal patients with more possible normal speech ability.Method Tracheo stoma of 18 alaryngeal patients who have undergone Blom Singer voice reconstructoin technique was connected with a handtailor manometer of millimeter water column.The pressure of tracheoesophageal air flow during pronuciation with 16 Fr or 20 Fr of prosthesis was determined.Laryngeal endoscope,monitor,video recorder,colour printer and stroboscope were intagrated to observe and study dynamic and static signs under neo glottis flash of ordinary light.In the same time,pronunciation effects (pronunciation time,count,audible distance,intelligible and fluency) were assessed and synchronizaton recording was also done.Result ①In the best pronunciation of alaryngeal patients who got recovery voice with Blome singer techniqe the average tracheoesophageal pressure was 45 mmH 2O.②When “yi” voice was pronounced,the shape of neo glottis under ordinary light was mainly triangle or shuttle shape but the shape of neo glottis that oscillated well under stroboscope like vocal cord very much.There was double oscillation.The better the oscillation,the better the pronunciation effect.③In patients who had used 16 Fr or 20 Fr of prothesis,their pronunciation effect and the shape of the mouth of neoglottis had no marked difference.Conclusion The pronunciation effect depended on proper pressure of tracheoesophageal air flow and oscillation of the vibration body in the neo glottis but did not depend on the size of prosthesis and the shape of the placket of the neo glottis.

关 键 词：合喉切除 Blom-Simger法发音效果 相关因素 

分 类 号：R767[医药卫生—耳鼻咽喉科]