Nozaki Motohiro, Sakurai Hiroyuki, Takeuchi Masaki, Nakazawa Hiroaki, Sasaki Kenji
Department of Plastic Surgery, Tokyo Women's Medical University, Tokyo 162-8111, Japan.
J Plast Reconstr Aesthet Surg. 2007;60(3):217-22. doi: 10.1016/j.bjps.2006.10.009. Epub 2007 Jan 17.
Although the structural integrity of the hypopharynx can be readily restored in individuals who have undergone laryngopharyngoesophagectomy by transferring a segment of the jejunum by a microsurgical technique, rehabilitation is often hindered by voice loss. The outcomes achievable with conventional approaches of artificial voice box reconstruction have been, generally speaking, unsatisfactory. A new reconstructive technique was devised to create a connection between the tracheal stump and the neo-hypopharynx to shunt airflow for phonation. The technique consisted of modifying one of two jejunal segments nourished by a single vascular pedicle to make a side mucosal tube resembling an elephant's trunk. With the larger end of one segment connected to the tracheal stump, the side arm having a smaller calibre was connected to the neo-oesophagus which was reconstructed with the second jejunal segment. Upon recovery from the surgery, the patient was trained for phonation by shunting the airflow into the neo-pharyngoesophagus. A total of 39 individuals underwent the elephant trunk shunt procedure for voice restoration at our hospital during the past 10 years. Although phonation was restored in 28 patients who had survived the original disease, the speech was assessed in 11. The mean duration of follow up was 5.6 years. The quality of speech was considered to be adequate in all. The rehabilitation of individuals who had undergone laryngopharyngoesophageal resection was enhanced and the quality of life was improved by voice restoration. That objective is attainable by incorporating a jejunal segment that shunts airflow to the jejunal pouch, thereby enabling phonation.
尽管通过显微外科技术转移一段空肠，下咽的结构完整性在接受喉咽食管切除术的个体中可以很容易地恢复，但康复往往因声音丧失而受阻。一般来说，传统的人工喉重建方法所取得的效果并不理想。一种新的重建技术被设计出来，用于在气管残端和新下咽之间建立连接，以分流气流用于发声。该技术包括修改由单一血管蒂滋养的两段空肠中的一段，使其形成一个类似象鼻的侧黏膜管。将其中一段的较大端连接到气管残端，将管径较小的侧臂连接到用第二段空肠重建的新食管。手术后恢复后，通过将气流分流到新咽食管对患者进行发声训练。在过去10年里，共有39人在我院接受了象鼻分流手术以恢复声音。虽然28名在原发病中存活下来的患者恢复了发声，但对11名患者的语音进行了评估。平均随访时间为5.6年。所有人的语音质量都被认为是足够的。通过恢复声音，接受喉咽食管切除术的个体的康复得到了加强，生活质量得到了改善。通过纳入一段将气流分流到空肠袋的空肠段，从而实现发声，这一目标是可以实现的。
