Su C Y
Department of Otolaryngology, Chang Gung Memorial Hospital, Kaohsiung Hsien, Taiwan, R.O.C.
Eur Arch Otorhinolaryngol. 1997;254(8):401-4. doi: 10.1007/BF01642559.
A near-total laryngectomy or near-total laryngopharyngectomy with the creation of a speech shunt was carried out on 66 laryngopharyngeal cancer patients. Intelligible shunt speech was obtained in 50 patients (76%), while stenosis of the shunt occurred in 13 patients (20%), and asymptomatic aspiration in 4 (6%). Poor voice production was usually due to shunt stenosis, a fibrotic band surrounding the shunt, or local recurrence of tumor. Perioperative wound infection and postoperative irradiation did not interfere with the development of shunt speech. In 12 patients with shunt stenosis, revision surgeries were performed to augment the shunt openings. During these procedures, the stenotic shunt was opened and a silastic tube was introduced into the shunt lumen to serve as a stent. For the moderately to severely stenotic shunt, the mucosal defect present was covered with a free skin graft or a sternocleidomastoid myoperiosteal flap. Following treatment, results demonstrated that 10 of the 12 patients acquired satisfactory shunt speech. In two unsuccessful cases, the causes of failure were wound infection and graft necrosis and were presumed to be complications of previous irradiation.
对66例喉咽癌患者实施了近乎全喉切除术或近乎全喉咽切除术并建立了言语分流通道。50例患者（76%）获得了可理解的分流言语，13例患者（20%）出现了分流通道狭窄，4例患者（6%）出现了无症状误吸。语音质量差通常是由于分流通道狭窄、分流通道周围的纤维化带或肿瘤局部复发。围手术期伤口感染和术后放疗并未干扰分流言语的形成。12例分流通道狭窄患者接受了修复手术以扩大分流开口。在这些手术过程中，打开狭窄的分流通道，并将硅橡胶管插入分流管腔作为支架。对于中度至重度狭窄的分流通道，用游离皮片或胸锁乳突肌肌骨膜瓣覆盖存在的黏膜缺损。治疗后，结果显示12例患者中有10例获得了满意的分流言语。在两例失败的病例中，失败原因是伤口感染和移植皮片坏死，推测是先前放疗的并发症。
