喉全切除后气管造口扩大术及Blom-Singer在发音重建中的应用  

Tracheostoma Enlargement and Voice Prosthesis after Total Laryngectomy

作　　者：赵青[1] 陈金湘[1] 顾晓玲[1] 石宇江[1] 

机构地区：[1]江苏省江阴市人民医院耳鼻咽喉科,214400

出　　处：《中国眼耳鼻喉科杂志》2003年第6期379-380,共2页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：目的比较喉全切除术两种不同气管造口术式,讨论Blom-Singer技术在气管造口扩大术中的应用。方法回顾分析34例喉全切除病例,其中喉全切除+单纯皮肤气管缝合(直接缝合法)25例,喉全切除+双侧胸锁乳突肌胸骨端切断+Griffth气管造口扩大术(造口扩大法)9例,后9例安装了Blom-Singer发音管。结果 25例直接缝合法术后均需常规戴套管半年以上,并不同程度产生造口狭窄及外观畸形,呈碗状塌陷。采用造口扩大法的9例,术后无需戴管,且随访1年时造口处无明显狭窄。术后1年两种术式气管直径分别为0.96±0.14 cm和1.49±0.22 cm,直接缝合法明显小于造口扩大法(P<0.01)。Blom-Singer发音重建的患者中,6例发声良好,成功率为66.7%。结论采用气管造口扩大术气管造口狭窄率低,方便了患者的术后护理,并有利于Blom-Singer发音管的安装。Purpose To compare two different tracheostomal formation methods and discuss the application of Blom-Singer voice prosthesis after total laryngectomy. Methods 34 cases of tracheostoma were done with two different methods , traditional methods were used in 25 cases, and total laryngectomy plus detachment of sternal ends of the bilateral sternomastoid muscle and Griffth tracheostoma enlargemnt were performed on the other 9 cases. Blom-singer voice prosthesis were applied to the latter 9 case. Results The patients with traditional tracheostoma formation method needed cannulation for more than six months, while the patients received tracheostoma enlargement operation needed didn't any cannulation. A follow up done a year later showed the average diameter of the tracheostoma were 0.96 ± 0.14 cm and 1 .49 ?.22 cm for the two methods respectively. No obvious stricture and bowl shaped collapse were found in a one-year follow up in the patients who received the tracheostoma enlargement among the 9 cases with voice prostheses. Six patients could speak freely, who made up 66.7 % of the total cases. Conclusion The combined tracheostorna enlargement method makes the installation and postoperative care of the prosthesis easier,Blom-singer voice prosthesis is a more valuable and easier method for patients after total laryngectomy.

关 键 词：喉全切除术 术后 气管造口扩大术 Blom-Singer 发音重建 喉癌 

分 类 号：R739.65[医药卫生—肿瘤] R730.56[医药卫生—临床医学]