Su C Y, Lui C C, Liao T Y
Department of Otolaryngology, Chang Gung University, Chang Gung Memorial Hosptal, Department of Otolaryngology, Chang Gung University, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Taiwan.
Laryngoscope. 1999 Feb;109(2 Pt 1):226-9. doi: 10.1097/00005537-199902000-00011.
Near-total laryngectomy with creation of a speaking shunt is generally considered suitable treatment for most T3 and some T4 laryngopharyngeal cancers. In some patients, poor speech production by the shunt can be problematic and usually means that a shunt lumen is stenotic or too small. Conventional axial computed tomography (CT) of the neck is of little value in predicting the shunt function and the patency of the shunt lumen. Such defect, however, can be better overcome if the spiral CT is used.
This study was designed to evaluate the dynamic speaking shunt by spiral CT and a three-dimensional (3-D) imaging model of the upper airway in 59 near-total laryngectomies.
During scanning, the patients were asked to make a single, 20-second phonation. A high-quality 3-D surface model was then rendered at an independent workstation. The 3-D model took on the appearance of the speaking shunt which could serve as a tracheopharyngeal fistulography.
3-D reconstruction of the images could clearly demonstrate the dynamic anatomy and patency of the speaking shunt. We found the 3-D model to be of diagnostic value, particularly in the near-total laryngectomy patients with stenotic shunts. The most common site of stenosis was at the top portion of the shunt.
The 3-D image findings of the shunts significantly improved the assessment and therapies of the patients undergoing revision surgeries of the shunt stenoses.
对于大多数T3期和部分T4期喉咽癌患者，行近全喉切除术并建立发音分流通常被认为是合适的治疗方法。在一些患者中，分流导致的发音不佳可能会成为问题，这通常意味着分流管腔狭窄或过小。传统的颈部轴向计算机断层扫描（CT）在预测分流功能和分流管腔通畅性方面价值不大。然而，如果使用螺旋CT，这种缺陷可以得到更好的克服。
本研究旨在通过螺旋CT和三维（3-D）上气道成像模型评估59例近全喉切除术中的动态发音分流情况。
扫描过程中，要求患者进行一次持续20秒的发声。然后在独立工作站生成高质量的3-D表面模型。该3-D模型呈现出发音分流的外观，可作为气管咽瘘造影。
图像的3-D重建能够清晰显示发音分流的动态解剖结构和通畅情况。我们发现3-D模型具有诊断价值，尤其对于分流狭窄的近全喉切除患者。最常见的狭窄部位在分流的顶部。
分流的3-D图像结果显著改善了接受分流狭窄修复手术患者的评估和治疗。
