Ku P K M, Abdullah V J, Vlantis A C, Lee K Y S, van Hasselt A C, Tong M C F
Department of Otorhinolaryngology, Head and Neck Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
J Laryngol Otol. 2009 Dec;123(12):1360-3. doi: 10.1017/S0022215109990351. Epub 2009 Jul 1.
The surgical treatment of intractable aspiration usually requires sacrifice of the patient's natural voice to prevent food entering the airway. Biller described a tubed supraglottic laryngoplasty to control aspiration while allowing patients to phonate with their larynx. Our preliminary experience with this technique in Chinese patients has been disappointing, as tension in the mucosa on wound closure led to wound dehiscence. Our objective was to modify Biller's technique in order to achieve a better outcome.
We modified Biller's technique by trimming the epiglottic cartilage and by inserting a tibial periosteal graft to reinforce closure of the mucosa, creating an arrangement resembling a Chinese steam boat.
Three Chinese patients underwent the modified Biller's technique. No wound dehiscence occurred, the surgery controlled aspiration, and the patients were able to phonate with their own larynx. All patients resumed oral feeding, and previously placed gastrostomy tubes were removed.
The 'steam-boat' supraglottic laryngoplasty is a viable surgical alternative to total laryngectomy or tracheal diversion for controlling intractable aspiration, and preserves a phonating larynx.
顽固性误吸的手术治疗通常需要牺牲患者的自然嗓音以防止食物进入气道。比勒描述了一种带管声门上喉成形术，用于控制误吸，同时让患者能够用喉部发声。我们在中国患者中应用该技术的初步经验并不理想，因为伤口闭合时黏膜张力导致伤口裂开。我们的目标是改进比勒的技术以获得更好的效果。
我们通过修剪会厌软骨并插入胫骨骨膜移植物来加强黏膜闭合，对比勒的技术进行了改进，形成了一种类似中国汽船的结构。
三名中国患者接受了改良的比勒技术。未发生伤口裂开，手术控制了误吸，患者能够用自己的喉部发声。所有患者恢复了经口进食，先前放置的胃造瘘管被拔除。
“汽船”声门上喉成形术是一种可行的手术选择，可替代全喉切除术或气管改道术来控制顽固性误吸，并保留发声喉部。
