Amatsu M, Makino K, Kinishi M, Tani M, Kokubu M
Auris Nasus Larynx. 1985;12 Suppl 2:S200-5. doi: 10.1016/s0385-8146(85)80059-6.
Out of a total of 113 consecutive tracheoesophageal (TE) shunt operations for postlaryngectomy voice restoration in the past 8 years performed at the Department of Otorhinolaryngology, 92 patients (81%) succeeded in the postoperative TE speech. The essential part of this surgery consists of the construction of the TE shunt using the membraneous part of the trachea obtained at surgery. In the course of 8 years, important changes have been employed for the prevention of aspiration. We attempted to combine primary cancer surgery with the creation of intelligible voice, but without aspiration. For the above purpose, we have employed the bilateral esophageal muscle flaps (BEMF) against aspiration in combination with the TE shunt construction for phonation. Sixteen of 18 patients thus operated on complained of no aspiration even with a drop of saliva and dietary fluids. As far as the mechanism against aspiration is concerned, both dilatation and elevation of the cervical esophagus during deglutition, together with the BEMF, seem to approximate the sphincter mechanism against tracheal reflux. A proper case selection may achieve high success rates for preserving normal deglutition and restoring speech after total laryngectomy.
在过去8年里，耳鼻咽喉科连续进行了113例喉切除术后语音恢复的气管食管（TE）分流手术，其中92例（81%）患者术后成功实现了TE语音。该手术的关键部分包括利用手术中获取的气管膜部构建TE分流。在8年的时间里，为预防误吸采用了重要的改进措施。我们试图将原发性癌症手术与清晰语音的形成相结合，同时避免误吸。为实现上述目的，我们采用双侧食管肌瓣（BEMF）预防误吸，并结合TE分流构建进行发声。接受该手术的18例患者中有16例表示，即使有一滴唾液或流食也不会出现误吸。就预防误吸的机制而言，吞咽时颈段食管的扩张和抬高，与BEMF一起，似乎接近防止气管反流的括约肌机制。合理的病例选择可能会在全喉切除术后保留正常吞咽功能和恢复语音方面取得较高的成功率。
