Department of Otolaryngology, Namik Kemal University Medicine Faculty, Tekirdag, Turkey.
J Voice. 2011 Mar;25(2):245-8. doi: 10.1016/j.jvoice.2009.10.011. Epub 2010 Feb 26.
To compare the short-term speech success of voice prosthesis (VP) among patients who underwent total laryngectomy or total laryngectomy in combination with neck dissection and those who received postoperative radiotherapy.
Thirty-two male patients treated for laryngeal squamous cell carcinoma were included. Nine patients underwent total laryngectomy and 23 underwent total laryngectomy combined with neck dissection, and 17 of the 23 with neck dissection were managed with postoperative radiotherapy (45-75 Gy). All of the patients had indwelling intraoperative placement of the Provox VP (Atos Medical AB, Horby, Sweden; and Entermed BV, Woerden, The Netherlands) at the time of the primary tracheoesophageal puncture (TEP) completed in conjunction with total laryngectomy. Patients with pharyngoesophageal myotomy and pharyngeal plexus neurectomy were excluded. Patients' speech success was perceptually evaluated 3-4 weeks after the surgery and 3-4 weeks after the cessation of radiotherapy, using a 1-3 scale (1 = failure to develop speech (aphonia); 2=communicate with short phrases only; and 3 = communicate with fluency and long sentences).
No complications were noted with intraoperative prosthesis placement. No prostheses were dislodged in the postoperative period. Eighteen of 32 patients (56%) demonstrated successful speech (rating of 3). Nine patients (28%) demonstrated less successful speech (rating of 2). Five patients (16%) were found to be aphonic (P > 0.05). Of the nine patients who underwent total laryngectomy only, six were found to have successful speech (66.6%), one (11.1%) was found to have less successful speech quality, and two (22.2%) patients were aphonic (P > 0.05). Of the six patients who underwent total laryngectomy in combination with neck dissection, three had successful speech (50%), one (16.6%) had less successful speech, and two (33.3%) were aphonic (P > 0.05). Of the 17 patients who received postoperative radiotherapy, nine (52.9%) had successful speech, three (17.6%) had less successful speech, and five (29.4%) were aphonic (P > 0.05).
Neck dissection and postoperative radiotherapy have no significant influence on short-term speech success in VP restoration patients. Primary TEP should be preferred in patients who have laryngectomy in combination with neck dissection and/or will have postoperative radiation therapy, as it provides early and successful voice restoration without interfering with radiation treatment and avoids a second surgical intervention.
比较全喉切除术或全喉切除术联合颈清扫术患者与接受术后放疗患者的喉假体（VP）短期言语成功率。
纳入 32 名接受喉鳞癌治疗的男性患者。9 名患者行全喉切除术，23 名患者行全喉切除术联合颈清扫术，其中 23 名颈清扫术患者中有 17 名接受术后放疗（45-75 Gy）。所有患者在初次气管食管穿刺（TEP）时均在术中留置 Provox VP（Atos Medical AB，Horby，瑞典和 Entermed BV，Woerden，荷兰），与全喉切除术同时进行。排除行咽食管肌切开术和咽丛神经切除术的患者。术后 3-4 周和放疗结束后 3-4 周，采用 1-3 级评分（1=言语无法恢复（失音）；2=仅能短句交流；3=流利长句交流）对患者的言语成功率进行感知评估。
术中假体放置无并发症。术后无假体移位。32 例患者中有 18 例（56%）言语成功（评分 3 级）。9 例（28%）言语成功率较低（评分 2 级）。5 例（16%）患者失音（P>0.05）。仅行全喉切除术的 9 例患者中，6 例言语成功（66.6%），1 例（11.1%）言语质量较低，2 例（22.2%）失音（P>0.05）。行全喉切除术联合颈清扫术的 6 例患者中，3 例言语成功（50%），1 例（16.6%）言语质量较低，2 例（33.3%）失音（P>0.05）。行术后放疗的 17 例患者中，9 例（52.9%）言语成功，3 例（17.6%）言语质量较低，5 例（29.4%）失音（P>0.05）。
颈清扫术和术后放疗对 VP 修复患者的短期言语成功率无显著影响。对于行喉切除术联合颈清扫术和/或术后放疗的患者，应首选初次 TEP，因为它可以在不干扰放疗的情况下提供早期和成功的嗓音恢复，避免二次手术干预。
