Landsberg R, Korenbrot F, Ophir D
Dept. of Otolaryngology, Meir Hospital, Kfar Saba.
Harefuah. 2000 Apr 16;138(8):643-6, 711.
Total laryngectomy due to malignant laryngeal tumors is followed by loss of speaking ability. Voice restoration in laryngectomized patients is the main target in their rehabilitation. Until the late 70's, esophageal speech was considered the most effective rehabilitation method. In 1980 Singer and Blom introduced a prosthesis for tracheoesophageal speech which has been gaining popularity. Tracheoesophageal puncture (TEP) can be performed either at the time of total laryngectomy, or later. 30 of our patients underwent TEP between 1991 and 1999, 15 at the time of total laryngectomy and 15 as a delayed secondary procedure. Mean follow-up was 36 months (range 6 months to 8 years) during which all regained speaking ability. Over the long range, speech rehabilitation with the prosthesis was successful in 24 (80%). In only 1 in the primary TEP group did treatment fail, as the prosthesis had to be removed due to local recurrence of the tumor. Long range failure in 5/15 patients after secondary TEP stemmed from difficulties some patients had in handling the prosthesis and from psychological difficulties in adapting to the new speech device. Complications were mostly minor and occurred mainly in the secondary TEP group. TEP performed at the time of total laryngectomy, or later as a secondary procedure, is effective for speech rehabilitation after laryngectomy.
由于喉恶性肿瘤而进行的全喉切除术会导致说话能力丧失。喉切除患者的语音恢复是其康复的主要目标。直到70年代末，食管语音被认为是最有效的康复方法。1980年，辛格和布洛姆引入了一种用于气管食管语音的假体，该假体越来越受欢迎。气管食管穿刺（TEP）可以在全喉切除术时进行，也可以在之后进行。我们的30例患者在1991年至1999年间接受了TEP，其中15例在全喉切除术时进行，15例作为延迟的二期手术。平均随访时间为36个月（范围为6个月至8年），在此期间所有患者都恢复了说话能力。从长远来看，使用该假体进行语音康复的成功率为24例（80%）。在初次TEP组中只有1例治疗失败，因为由于肿瘤局部复发不得不取出假体。二期TEP后15例患者中有5例长期失败，原因是一些患者在使用假体时存在困难以及在适应新的语音装置方面存在心理障碍。并发症大多较轻，主要发生在二期TEP组。在全喉切除术时进行的TEP，或之后作为二期手术进行的TEP，对喉切除术后的语音康复是有效的。
