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目的 :探讨气管食管裂隙状发声孔的发声机制。方法 :用大功率遥控X线机和动态频闪喉镜观察4 0例行全喉切除 ,Ⅰ期或Ⅱ期发声重建术患者发声时的贮气相、送气相、发声相。结果 :患者吸气时肺部膨隆 ,食管黏膜闭拢 ;食管入口黏膜内翻呈环形缩小 ;随之 ,下咽腔增大呈一尖端向下的三角锥形 ;食管上端迅速膨大。发声开始时 ,食管上端扩张如球 ,食管入口黏膜以冠状位呈唇样外翻 ,气体从咽食管部冲出 ;黏膜、黏液发生振动 ,发出基音。后胸廓缩小 ,食管入口黏膜再次内翻 ,发声结束。结论 :气管食管音发声的动力器官是肺 ,气管 食管造瘘口的通畅对发声至关重要。发声时 ,下咽黏膜、食管口黏膜与黏液均参与振动。
Objective: To investigate the vocal mechanism of the tracheoesophageal fissure sound hole. Methods: 40 patients undergoing total laryngectomy and stage Ⅰ or Ⅱ vocal reconstruction were enrolled in this study. Gas phase, gas phase and phonation phase were observed with high power remote X ray machine and dynamic stroboscopic laryngoscope. Results: The lungs of the patients were inflated and the esophageal mucosa was closed. The invagination of the esophageal mucosa turned annularly narrowed. In addition, the lower pharynx enlarged into a triangular pyramid with a sharp downward tip. The upper esophagus rapidly swelled. Voice began, the upper esophagus expansion such as the ball, esophageal mucosa was lip-like coronal eversion, gas escaping from the pharyngeal esophagus; mucosa, mucus vibration, pronounce the pitch. After the thoracic narrowing, esophageal mucosa again inverted, ending sound. CONCLUSIONS: Tracheal esophageal sounds are vital organs of the lungs and tracheoesophageal stomas. Vocalization, pharyngeal mucosa, esophageal mucosa and mucus are involved in vibration.