Suits G W, Cohen J I, Everts E C
Department of Otolaryngology/Head and Neck Surgery, Oregon Health Sciences University, Portland, USA.
Arch Otolaryngol Head Neck Surg. 1996 May;122(5):473-5. doi: 10.1001/archotol.1996.01890170009003.
To investigate the speech and swallowing outcomes of patients undergoing near-total laryngectomy and to determine those perioperative factors that are associated with success.
Retrospective analysis of a case series obtained from a hospital-based academic tertiary care center.
Records of all patients who underwent near-total laryngectomy at this institution were reviewed.
Wound healing problems, quality of speech, degree of aspiration, and need for shunt revision were recorded.
Thirty-nine patients during a 10-year period underwent near-total laryngectomy. Good speech was obtained in 30 (76%). Severe aspiration was a complication in eight patients (21%), necessitating reversal of the shunt in four (10%). Certain technical aspects of this procedure that produce a "hooded" myomucosal shunt were crucial to proper shunt function. Severe aspiration and poor voice outcome were most likely in patients who experienced a postoperative pharyngocutaneous fistula. These fistulas tended to occur at the junction of the pharynx and the upper end of the myomucosal shunt. When this region broke down, the hooding of the shunt was disrupted and its function impaired.
Careful patient selection is crucial to the creation of a functional myomucosal speaking shunt after near-total laryngectomy. In patients at high risk for developing a pharyngocutaneous fistula, where irreversible aspiration through the shunt is then likely, this operation should be avoided and a total laryngectomy with tracheoesophageal puncture considered instead.
研究接受次全喉切除术患者的言语和吞咽结果，并确定与手术成功相关的围手术期因素。
对来自一家医院学术三级护理中心的病例系列进行回顾性分析。
回顾了在该机构接受次全喉切除术的所有患者的记录。
记录伤口愈合问题、言语质量、误吸程度以及分流管修订需求。
在10年期间，39例患者接受了次全喉切除术。30例（76%）患者获得了良好的言语效果。8例患者（21%）出现严重误吸并发症，其中4例（10%）需要对分流管进行复位。该手术中产生“带帽”肌黏膜分流管的某些技术方面对分流管的正常功能至关重要。术后发生咽皮肤瘘的患者最有可能出现严重误吸和声音效果不佳的情况。这些瘘管往往发生在咽部与肌黏膜分流管上端的交界处。当该区域出现破损时，分流管的帽状结构被破坏，其功能受损。
仔细选择患者对于次全喉切除术后创建功能性肌黏膜发音分流管至关重要。对于发生咽皮肤瘘风险较高的患者，随后可能会通过分流管出现不可逆的误吸，应避免进行该手术，而考虑行全喉切除术并进行气管食管穿刺。
