咽食管括约肌切开术在喉全切除术后发音重建中的作用

目的　探讨咽食管括约肌切开术对减少咽食管括约肌失弛缓对喉全切除术后安装Blom Singer发音管发音重建的影响。方法　喉全切除术后 ,咽食管括约肌收缩或是痉挛都会不同程度地影响食管的气流并阻碍发音。咽食管括约肌的解剖位置是环咽肌以及其上的下咽缩肌的一部分和颈段食管上段的一部分。手术操作是在喉全切除术中、术后于气管造瘘口外上方切除长 5cm ,宽 1cm的咽食管括约肌。结果　 3 3例喉全切除术的患者进行咽食管括约肌切开术后有 3 2例发音成功 ,发音重建的成功率是 97%。其中包括 12例喉全切除术中I期进行环咽肌切开术 ,2 1例是Ⅱ期进行咽食管括约肌切开术的 ,后者又有 9例是安装Blom Singer发音管后发音不能再行咽食管括约肌切开术的。患者 3年存活 2 5例 ,5年存活 18例。同期行喉全切除术和咽食管括约肌切开术的 12例患者 ,Kaplan Meier法统计 3年生存率 81 82 % ,5年生存率 42 86%。结论　咽食管括约肌切开术能提高Blom Singer发音管发音重建的成功率。

Pharyagoesophageal sphinoter myotomy for voice rehabilitation after total laryngectomy

Objective In those patients received total laryngectomy, Blom Singer prosthesis speech appears to be the more effective form of rehabilitation To reduce the effect of pharyngoesophageal sphincter on the Blom Singer prosthesis voice restoration following total laryngectomy, the pharyagoesphageal sphincter myotomy was designed and carried out Methods After total laryngectomy, the cricopharyngeus muscle stricture or spasm appears to inhibit the air flowing and prevent the speech The pharyngoesophageal sphincter is now defined as the area including the cricopharyngeus with a portion of inferior constrictor, as well as some of the upper cervical esophagus The pharyngoesophageal sphincter were incised intra and post operation of total laryngectomy, the dissection was approximately 5cm in vertical length and 1cm in width Results Among the 33 patients who received pharyngoesophageal sphincter myotomy following total laryngectomy , voice restoration was achieved in 32 cases, the success rate was 97% 25 patients had survived for 3 years, 18 patients survived for 5 years Conclusion Pharyagoesophageal sphinoter myotomy can raise the success rate of rehabilitation of the voice by Blom Singer prosthesis