近全喉切除術後氣管咽部分流之功能預測：一病例報告

喉癌（laryngeal carcinoma）及下咽癌（hypopharyngeal carcinoma）是耳鼻喉頭頸外科常見的癌症，以往接受全喉切除術的晚期喉癌及下咽癌患者，常造成病人術後發音及吞嚥上的困難。在近年影像醫學及外科技巧提昇後，許多醫師嚐試以近全喉切除術（near-total laryngectomy）保留更多正常咽喉結構，同時重建發音管道，以避免手術後發音及吞嚥上之困難。本病例為一下咽癌合併上喉侵犯患者，接受近全喉切除術及右側改良型頸部淋巴廓清術（modified radical neck dissection），術中以氣管咽部分流（tracheo-pharyngeal shunt）重建發音功能，術後傷口癒合良好無手術併發症。我們以鼻阻力測量儀（Rhinomanometry NR6）測量病患發音時分流壓力，以早期預測氣管咽部分流手術的成功與否，幫助醫師決定是否持續為病人做音聲復健或是需要補救手術。所得結果顯示確可供作預測氣管咽部分流功能之參考。

關鍵字

近全喉切除術；氣管咽部分流；鼻阻力測量儀

並列摘要

Laryngeal and hypopharyngeal carcinoma is not uncommon in the patients of Head and Neck surgery department. In early days, patients received total laryngectomy for treatment of late stages of laryngeal or hypopharyngeal carcinoma. Unfortunately, dysphonia and dysphagia developed after surgery. In the past twenty years, near-total laryngectomy has become a popular method for treating these late stage patients. The benefit of near-total laryngectomy is that it preserves more normal tissue for organic function, while still maintains a similar cure rate comparing to that of total laryngectomy. We presented a case who is a victim of advanced hypopharyngeal carcinoma with stage of T3N0M0. The surgical intervention included a near-total laryngectomy, right side modified radical neck dissection, and the reconstruction of a tracheo-pharyngeal shunt. The post-operative function of the shunt was evaluated by measuring the resistance during phonation, which showed to be in good condition. The patient was good during the five months follow-up period. Our case report supports the notion that a successful near-total laryngectomy may partly preserve the phonation function and improve the life quality of patients with advanced hypopharyngeal carcinoma.

並列關鍵字

near-total laryngectomy ； tracheo-pharyngeal shunt ； rhinomanometry

國際替代計量

近全喉切除術後氣管咽部分流之功能預測：一病例報告

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