Tarnowska Czesława, Grochowska-Bohatyrewicz Ewa, Bień Stanislaw, Sieczka Jarosław, Jaworowska Ewa, Lubiński Jakub
Katedra i Klinika Otolaryngologii i Onkologii, Laryngologicznej Pomorskiej Akademii Medycznej--Szczecin.
Otolaryngol Pol. 2010 Jan-Feb;64(1):37-42. doi: 10.1016/S0030-6657(10)70033-0.
High pressure of pharyngo-esophageal segment is the most important factor of impaired development of alaryngeal speech (esophageal speech, tracheoesophageal speech) after total laryngectomy. To prevent pharyngo-esophageal spasm in Department of Otolaryngology in Szczecin are used: pharyngoesophageal plastic surgery with interposition of vascular thyroid flap, two-layer (only mucosa) non-muscular pharyngeal closure and tree-layer closure (mucosa and muscle layer leaving inferior pharyngeal constrictor unsutured).
The aim of this study was to compare the pharyngo-esophageal pressure between patients after pharyngo-esophageal plastic surgery and following the non-muscular pharyngeal closure.
One hundred eighty two subjects after total laryngectomy were enrolled in this study, and included 108 patients subjected to the pharyngo-esophageal plastic surgery, 44 patients who underwent the two-layer pharyngeal closure, and 30 patients with the tree-layer closure. To evaluate the pharyngo-esophageal pressures manometric tests were performed, and to asses the pharynx morphology videopharyngoscopy was used.
The average pharyngo-esophageal pressure in the group after the pharyngo-esophageal plastic surgery was 32 (min.-5, max. 50) mmHg. After the two-layer non-muscular pharyngeal closure mean pressure was 35 (min.-17, max.-40) mmHg, and after the tree-layer non-muscular pharyngeal closure the average pressure was 22,42 (min. 5, max. 40) mmHg. The average pharyngo-esophageal pressure was significantly lower (p < 0.01) among patients after the tree-layer non-muscular closure.
The study suggests that the tree-layer non-muscular pharyngeal closure with inferior pharyngeal constrictor unsutured is the preferable method to prevent pharyngo-esophageal spasm after total laryngectomy. However, the efficacy and safety of this surgical procedure should be explored in further multicenter studies.
下咽-食管段高压是全喉切除术后无喉语音（食管语音、气管食管语音）发育受损的最重要因素。在什切青的耳鼻喉科，为预防下咽-食管痉挛采用了以下方法：带血管甲状腺瓣植入的下咽-食管整形手术、两层（仅黏膜）无肌层咽闭合术和三层闭合术（黏膜和肌层，咽下缩肌不缝合）。
本研究的目的是比较下咽-食管整形手术后患者与无肌层咽闭合术后患者的下咽-食管压力。
本研究纳入了182例全喉切除术后的受试者，其中108例行下咽-食管整形手术，44例行两层咽闭合术，30例行三层闭合术。采用测压试验评估下咽-食管压力，使用视频喉镜评估咽部形态。
下咽-食管整形手术组的平均下咽-食管压力为32（最小值-5，最大值50）mmHg。两层无肌层咽闭合术后平均压力为35（最小值-17，最大值-40）mmHg，三层无肌层咽闭合术后平均压力为22.42（最小值5，最大值40）mmHg。三层无肌层闭合术后患者的平均下咽-食管压力显著较低（p<0.01）。
该研究表明，不缝合咽下缩肌的三层无肌层咽闭合术是预防全喉切除术后下咽-食管痉挛的优选方法。然而，该手术方法的有效性和安全性应在进一步的多中心研究中进行探索。
