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目的:探讨全喉切除后寻找最佳发声位置与可行的措施。方法:全喉切除安装发音管健在的33例患者,有12例不能发声,选择10例作为失声组;在发声病例中选择10例性别、年龄、病理类型、手术方式较接近者为发声组。分别进行食管上端测压、充气发声试验、吞钡检查及纤维喉镜检查。结果:前鼻孔至食管入口、最佳发声位置、发音管水平距离两组均无差异。发声充气试验显示,发音管水平失声组无一例发声阳性;发声组7例阳性,3例阴性。最佳发声位置,失声组在发音管水平上方3.6cm,发声组在2.0cm处。食管上端测压显示,食管入口下1.0cm与发音管水平下2.0cm压力较低,2组差异无统计学意义(P>0.05)。发音管水平压力较高,2组差异有统计学意义(P<0.01)。失声组4例简易型食管音发声器试用均可发声,发声组中1例应用亦能发声。结论:发音管平面、失声组压力明显高于发声组,是不能发声的主要因素。2组在食管入口下方可找到最佳发声位置,该位置下方是压力最高的发音管平面,可有效阻止气流向下进入胃内,从而解决了失声组不能发声的问题,提高了发声成功率。若使发声气流到达该处,可通过手术;发音管改革;食管音发声器均可将气流引入该处。
Objective: To explore the best vocal position after total laryngectomy and feasible measures. Methods: Total throat excision was performed in 33 patients with sound tube. There were 12 patients who could not vocal and 10 patients as vocal group. Among the vocal cases, 10 patients were sex, age and pathological type. Respectively upper esophageal pressure measurement, inflation vocalization test, barium swallow and fiberoptic examination. Results: The anterior nostril to esophageal entrance, the best vocal position, the sound tube horizontal distance between the two groups were no differences. Voiced inflatable test showed that no sound vocalization level was found in the vocal tube at the level of vocalization; 7 vocalizations were positive and 3 were negative. The best vocal position, noise group at the tone tube above the level of 3.6cm, vocal group at 2.0cm. The upper esophageal pressure measurement showed that there was no significant difference between 1.0cm under esophageal entrance and 2.0cm under sound tube. There was no significant difference between the two groups (P> 0.05). The tone tube pressure is higher, the difference between the two groups was statistically significant (P <0.01). Voice loss group 4 cases of simple esophageal voice sounder trial can sound, voice group 1 case application can sound. Conclusion: The sound tube plane, the sound pressure group was significantly higher than the sound group, is the main factor can not sound. Group 2 below the esophageal entrance to find the best position of the sound, the location is under the highest pressure of the sound tube plane, which can effectively prevent the gas flow down into the stomach, thus solving the problem of speechless group can not sound, and improve the success rate of sound. If the sound flow to reach the place, by surgery; pronunciation tube reform; esophageal sounder can be introduced to the air flow.