Zacharek M A, Pasha R, Meleca R J, Dworkin J P, Stachler R J, Jacobs J R, Marks S C, Garfield I
Department of Otolaryngology Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan 48201, USA.
Laryngoscope. 2001 Sep;111(9):1558-64. doi: 10.1097/00005537-200109000-00012.
Local control and 5-year survival rates are similar for patients undergoing total laryngectomy and supracricoid laryngectomy for the treatment of advanced-stage laryngeal carcinoma. However, comprehensive studies of functional outcomes after supracricoid laryngectomy are lacking.
Cohort study.
This investigation provides objective voice laboratory data, skilled listener impressions of voice samples, swallowing evaluations, and patient self-perceptions of speech ability obtained from 10 supracricoid laryngectomees.
Results demonstrated variable acoustic and speech aerodynamic disturbances, hoarse-breathy vocal quality, and speech dysfluency. Patients' self-perceptions of voice revealed severe dysphonia that induced certain emotional, physical, and functional setbacks. However, blinded judges rated these individuals as possessing intelligible speech and communication skills. All patients demonstrated premature spillage of the bolus and varying degrees of laryngeal penetration, aspiration, and retention during swallowing studies. However, each patient used a compensatory strategy to protect the airway. Voice and swallowing abilities appeared to depend on the mobility of the arytenoid cartilages, base of tongue action, and residual supraglottic tissue for the creation of a competent neoglottal sphincter complex that vibrated during phonation efforts and protected the airway during deglutition.
Supracricoid laryngectomy avoids the potential complications, limitations, and emotional problems associated with a permanent tracheostoma. All patients demonstrated intelligible voice and effective swallowing function postoperatively, supporting supracricoid laryngectomy as a suitable alternative surgical approach to the total laryngectomy in select patients.
对于接受全喉切除术和环状软骨上喉切除术治疗晚期喉癌的患者，局部控制率和5年生存率相似。然而，缺乏对环状软骨上喉切除术后功能结果的综合研究。
队列研究。
本研究提供了从10例环状软骨上喉切除患者获得的客观语音实验室数据、专业听众对语音样本的印象、吞咽评估以及患者对言语能力的自我认知。
结果显示存在可变的声学和言语空气动力学干扰、嘶哑-呼吸性嗓音质量和言语不流畅。患者对嗓音的自我认知显示出严重的发音障碍，这导致了某些情绪、身体和功能上的挫折。然而，不知情的评委将这些患者评定为具有可理解的言语和沟通能力。在吞咽研究中，所有患者均表现出食团过早溢出以及不同程度的喉穿透、误吸和潴留。然而，每位患者都采用了代偿策略来保护气道。嗓音和吞咽能力似乎取决于杓状软骨的活动度、舌根的作用以及残余的声门上组织，以形成一个有效的新声门括约肌复合体，该复合体在发声时振动并在吞咽时保护气道。
环状软骨上喉切除术避免了与永久性气管造口相关的潜在并发症、局限性和情绪问题。所有患者术后均表现出可理解的嗓音和有效的吞咽功能，支持环状软骨上喉切除术作为特定患者全喉切除术的一种合适的替代手术方法。
