Debry Christian, Dupret-Bories Agnes, Vrana Nihal E, Hemar Patrick, Lavalle Philippe, Schultz Philippe
Institut National de la Santé et de la Recherche Médicale, INSERM, UMR-S 1121, "Biomatériaux et Bioingénierie," 11 rue Humann, F-67085, Strasbourg Cedex, France; Faculté de Chirurgie Dentaire, Université de Strasbourg, 1 Place de l'Hôpital, 67000, Strasbourg, France; Hôpitaux Universitaires de Strasbourg, Service Oto-Rhino-Laryngologie, 67098, Strasbourg, France.
Head Neck. 2014 Nov;36(11):1669-73. doi: 10.1002/hed.23621. Epub 2014 Jun 21.
Most patients perceive total laryngectomy as a mutilation carrying with it a loss of physical and psychological integrity. Thus, an artificial larynx system that can replace the laryngeal functions would significantly improve the quality of life for the afflicted patients.
This report, with accompanying video, presents the first case in an ongoing clinical trial of laryngeal rehabilitation using an artificial larynx after total laryngectomy for squamous cell carcinoma, for an 8-month follow-up period. We depict the prosthesis' features, our 2-step surgical procedure, and the outcome. The prosthesis is formed of 2 parts: (1) a tracheal prosthesis with a porous titanium junction with trachea, which was implanted in the first step to ensure its colonization, and (2) a removable part composed of concentric valves that enable inhalation and exhalation. The second part was implanted endoscopically. The implant was monitored with a retrograde nasofibroscopy of the tracheal prosthesis lumen and CT scans over a course of 8 months.
The patient's functioning in the relevant postoperative problem areas, such as swallowing, breathing, and smelling, has significantly improved. The patient was able to talk in a whispering fashion while the tracheostomy was temporarily closed. The implant's porous part was in the process of being colonized by the surrounding tissue and no fistulas were observed as evidenced by barium swallow.
As the current case shows, tracheotomy closure can be performed, and laryngeal functions are restored, by means of an implant. With further improvements, this system can alleviate the need for a permanent tracheostomy after total laryngectomy, while maintaining important larynx functions intact.
大多数患者认为全喉切除术是一种毁容性手术，会导致身体和心理完整性的丧失。因此，一种能够替代喉部功能的人工喉系统将显著改善患病患者的生活质量。
本报告及随附视频展示了在一项正在进行的临床试验中的首例病例，该试验针对一名因鳞状细胞癌接受全喉切除术后使用人工喉进行喉部康复的患者，随访期为8个月。我们描述了假体的特征、两步手术过程及结果。该假体由两部分组成：（1）一个带有与气管相连的多孔钛连接部的气管假体，在第一步植入以确保其定植；（2）一个由同心瓣膜组成的可移除部分，用于实现吸气和呼气。第二部分通过内镜植入。在8个月的过程中，通过对气管假体腔进行逆行鼻纤维镜检查和CT扫描对植入物进行监测。
患者在吞咽、呼吸和嗅觉等相关术后问题领域的功能有显著改善。在气管造口术暂时关闭时，患者能够低声说话。植入物的多孔部分正在被周围组织定植，钡餐检查未发现瘘管。
如当前病例所示，通过植入物可实现气管造口术闭合并恢复喉部功能。随着进一步改进，该系统可减少全喉切除术后对永久性气管造口术的需求，同时保持重要的喉部功能完整。
