Deschler Daniel G, Bunting Glenn W, Lin Derrick T, Emerick Kevin, Rocco James
Massachusetts Eye and Ear Infirmary, Division of Head and Neck Surgery, Department of Otology and Laryngology, Harvard Medical School, Boston 02114, Massachusetts, USA.
Laryngoscope. 2009 Jul;119(7):1353-7. doi: 10.1002/lary.20490.
OBJECTIVES/HYPOTHESIS: Primary tracheoesophageal puncture (TEP) is a well-described and accepted method of surgical voice restoration and is standardly completed with a catheter placement intraoperatively, which is replaced with a prosthesis at a later date. This study evaluates the intraoperative placement of the voice prosthesis at the time of the primary TEP in an effort to understand the potential advantages and disadvantages of voice prosthesis placement at the time of primary TEP completed in conjunction with total laryngectomy.
Retrospective chart review within an academic medical center.
After approval by the institutional review board of the Massachusetts Eye and Ear Infirmary, a retrospective chart review was completed of all cases of primary tracheoesophageal prosthesis placement completed in conjunction with primary tracheoesophageal puncture performed at the time of total laryngectomy.
Thirty patients were identified, 29 of whom underwent laryngectomy for advanced laryngeal carcinoma. Twenty-eight of 29 patients received preoperative full-dose radiation therapy. Twenty-nine of 30 patients had a 20F classic Indwelling Blom-Singer prosthesis (InHealth Technologies, Carpinteria, CA) placed. One had placement of 16F Indwelling Blom-Singer prosthesis. No complications were noted with intraoperative prosthesis placement. No prostheses were dislodged in the postoperative period. Twenty-nine of 30 subjects had initial success with tracheoesophageal voice production. At 1-year follow-up, 23/30 subjects (77%) had successful voice restoration. Five failed because of recurrent disease, one subject never achieved successful voice, and one subject wanted the prosthesis removed although successful voice was achieved. Twenty-three of 25 (92%) disease-free subjects had functional voice restoration at 1-year post-total laryngectomy and primary prosthesis placement.
This study demonstrates that the voice prosthesis can be safely and effectively placed intraoperatively at the time of primary TEP and laryngectomy. Initial voice acquisition rates were high and long-term success was well within the acceptable range.
目的/假设：一期气管食管穿刺（TEP）是一种已被充分描述且被认可的手术语音恢复方法，通常在术中完成导管置入，之后再更换为假体。本研究评估在一期TEP时术中放置语音假体的情况，以了解在全喉切除术联合一期TEP时放置语音假体的潜在优缺点。
在一所学术医疗中心进行回顾性病历审查。
经马萨诸塞州眼耳医院机构审查委员会批准，对全喉切除术时一期气管食管穿刺联合一期气管食管假体置入的所有病例进行回顾性病历审查。
共确定30例患者，其中29例因晚期喉癌接受了喉切除术。29例患者中有28例接受了术前全量放疗。30例患者中有29例置入了20F经典留置式Blom-Singer假体（InHealth Technologies，加利福尼亚州卡平特里亚）。1例置入了16F留置式Blom-Singer假体。术中假体置入未发现并发症。术后无假体移位。30例受试者中有29例初次尝试气管食管发音成功。在1年随访时，23/30例受试者（77%）语音恢复成功。5例因疾病复发失败，1例受试者从未成功获得语音，1例受试者尽管获得了成功语音但仍希望取出假体。25例无病受试者中有23例（92%）在全喉切除和一期假体置入后1年实现了功能性语音恢复。
本研究表明，在一期TEP和喉切除术时术中安全有效地放置语音假体是可行的。初次语音获得率较高，长期成功率在可接受范围内。
