Su C Y
Department of Otolaryngology, Chang Gung Medical College and Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Ann Otol Rhinol Laryngol. 1998 Jul;107(7):619-22. doi: 10.1177/000348949810700713.
A near-total operation to create a speaking shunt is generally considered a suitable option in most T3 laryngopharyngeal cancer cases. However, some of these cases incur postoperative problems, including aspiration and shunt stenosis. In this 8-year study, 15 of 60 patients who had received near-total laryngectomies could not speak well with their shunts. Revision surgery was performed on 11. Under local anesthesia, the lumen of the stenotic segment of the shunt was opened. A 4-F silicone tube was stented in the shunt. Then, for mildly stenotic cases, the small mucosal defect of the shunt was covered by a sternohyoid myofascial flap. For moderate to severe cases, the larger mucosal defect was reconstructed with a free skin graft. Thereafter, a sternohyoid muscle flap was used to cover the skin graft, which would finally form the inner lining of the new speaking shunt. The outcome was that 9 of the 11 patients acquired intelligible shunt speech. These results demonstrate that the augmentation procedures described herein have considerable potential for restoring the function of a stenotic speaking shunt in a near-total laryngectomy.
对于大多数T3期喉咽癌病例，近乎全喉切除术并建立发音分流通常被认为是一种合适的选择。然而，其中一些病例会出现术后问题，包括误吸和分流狭窄。在这项为期8年的研究中，60例接受近乎全喉切除术的患者中有15例使用分流装置后无法正常发声。对其中11例进行了修复手术。在局部麻醉下，打开分流狭窄段的管腔。在分流装置中置入一根4F硅胶管。然后，对于轻度狭窄病例，用胸骨舌骨肌肌筋膜瓣覆盖分流装置的小黏膜缺损。对于中重度病例，用游离皮片修复较大的黏膜缺损。此后，用胸骨舌骨肌瓣覆盖皮片，最终形成新的发音分流装置的内衬。结果是11例患者中有9例获得了可理解的分流语音。这些结果表明，本文所述的增强手术在恢复近乎全喉切除术后狭窄发音分流装置的功能方面具有相当大的潜力。
