van der Molen Lisette, Kornman Anne F, Latenstein Merel N, van den Brekel Michiel W M, Hilgers Frans J M
The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam Centre for Language and Communication, University of Amsterdam, Amsterdam, the Netherlands.
Curr Opin Otolaryngol Head Neck Surg. 2013 Jun;21(3):230-8. doi: 10.1097/MOO.0b013e3283610060.
Total laryngectomy rehabilitation (TLR) in Europe is not uniform, with quite some differences in approach and infrastructure between various countries. In, for example, the Netherlands, Switzerland, Scandinavia, and more recently also in the UK, head and neck cancer (HNC) treatment and rehabilitation shows a high level of centralization in dedicated HNC centres. In other European countries, the level of centralization is lower, with more patients treated in low-volume hospitals. This article focusses on the situation in the Netherlands and, where applicable, will discuss the regional variations in Europe.
Prosthetic surgical voice restoration (PSVR) presently is the method of choice in Europe, and use of oesophageal and electrolarynx voice has moved to the background. In most European countries (except the UK and Ireland), PSVR is physician driven, with an indispensable role for speech-language pathologists and increasingly for oncology nurses. Indwelling voice prostheses are mostly preferred, also because these devices can be implanted at the time of trachea-oesophageal puncture. Pulmonary rehabilitation is achieved with heat and moisture exchangers, which, based on extensive clinical and basic physiology research, are considered an obligatory therapy measure. In addition to PSVR, also issues such as smoking cessation, dysphagia/swallowing rehabilitation, and olfaction/taste rehabilitation are discussed. Especially, the latter has shown great progress over the last decade and is another example of increasing implementation of evidence-based practice in TLR.
TLR has shown considerable progress over the last decades, and through the intensified collaboration between all clinicians involved, significantly has improved vocal, pulmonary, and olfactory rehabilitation after total laryngectomy.
欧洲的全喉切除术康复（TLR）并不统一，各国在方法和基础设施方面存在相当大的差异。例如，在荷兰、瑞士、斯堪的纳维亚半岛，以及最近在英国，头颈癌（HNC）的治疗和康复在专门的HNC中心呈现出高度集中化。在其他欧洲国家，集中化程度较低，更多患者在规模较小的医院接受治疗。本文重点关注荷兰的情况，并在适用的情况下讨论欧洲的地区差异。
目前，人工喉手术语音恢复（PSVR）是欧洲的首选方法，食管语音和电子喉语音的使用已退居次要地位。在大多数欧洲国家（英国和爱尔兰除外），PSVR由医生主导，言语病理学家发挥着不可或缺的作用，肿瘤学护士的作用也日益凸显。留置式语音假体大多更受青睐，这也是因为这些装置可在气管食管穿刺时植入。通过热湿交换器实现肺部康复，基于广泛的临床和基础生理学研究，热湿交换器被视为一项必要的治疗措施。除了PSVR，还讨论了戒烟、吞咽困难/吞咽康复以及嗅觉/味觉康复等问题。特别是，后者在过去十年中取得了巨大进展，也是TLR中循证实践应用增加的另一个例子。
在过去几十年中，TLR取得了相当大的进展，通过所有相关临床医生之间加强合作，全喉切除术后的语音、肺部和嗅觉康复得到了显著改善。
