Balm A J M, van den Brekel M W M, Tan I B, Hilgers F J M
Otolaryngol Pol. 2011 Nov-Dec;65(6):402-9. doi: 10.1016/S0030-6657(11)70731-4.
Primary prosthetic voice restoration by performing tracheoesophageal puncture (TEP) and immediate insertion of a voice prosthesis at the time of total laryngectomy (TLE) is presently the method of choice. This enables the easiest and most comfortable voice rehabilitation with the patient still under general anesthesia when the first prosthesis is inserted. Reconstruction of the pharynx with e.g. free revascularized or pedicled flaps does not preclude surgical prosthetic voice restoration. The TEP can even be done as a primary procedure after total laryngectomy and total pharyngectomy when the full circumference of the neopharynx has to be reconstructed, provided the esophagus is still present at the level of the trachea. Since indwelling devices may have a more robust construction, their device-life generally is longer than that of their non-indwelling counterparts. Indwelling devices have the unique advantage in that patient's dexterity plays a lesser role in the daily maintenance of the device. With a few refinements in the surgery of TLE several postlaryngectomy problems can be avoided or diminished such as hypertonicity of the pharyngoesophageal (PE) segment and a poor contour of the stoma. The combination of Heat and Moisture Exchanger (HME) and indwelling voice prosthesis contributes to a significant improvement of both pulmonary function and voice quality. The solution of the majority of prosthesis and TE-fistula related problems by the well trained physician, make prosthetic voice restoration a safe procedure.
目前，通过在全喉切除术（TLE）时进行气管食管穿刺（TEP）并立即植入发音假体来进行一期假体发音重建是首选方法。这使得在首次植入假体时患者仍处于全身麻醉状态下就能实现最简单、最舒适的语音康复。用例如游离血管化或带蒂皮瓣重建咽部并不排除手术假体发音重建。当需要重建新咽部的整个周长时，即使在全喉切除术和全咽切除术后，只要气管水平仍存在食管，TEP甚至可以作为一期手术进行。由于留置装置可能具有更坚固的结构，其装置寿命通常比非留置装置更长。留置装置具有独特的优势，即患者的灵活性在装置的日常维护中所起的作用较小。通过对全喉切除术的手术进行一些改进，可以避免或减少一些喉切除术后的问题，例如咽食管（PE）段的张力亢进和造口轮廓不佳。热湿交换器（HME）和留置发音假体的结合有助于显著改善肺功能和语音质量。训练有素的医生解决大多数与假体和TE瘘相关的问题，使假体发音重建成为一种安全的手术。
