- 期刊
以前臂游離皮瓣及發聲管重建下咽癌全咽喉切除術病人的發聲言語機能
Radial Forearm Free Flap-accompanied Phonation Tube for Voice Restoration after Total Pharyngolaryngectomy
摘要
晚期下咽癌病患的手術組織缺損範圍大、重建較複雜，特別是在手術性的發聲言語功能重建方面更形困難。對於晚期下咽癌病人手術切除後所產生的大範圍組織缺損有許多修補及重建的方式，其中前臂游離皮瓣(radial forearm free flap)是一個可以信賴的選擇。本科於2005年6月經歷一例59歲男性晚期下咽癌患者，接受全咽喉切除術加上雙側頸部廓清術，以及採用前臂游離皮瓣併發聲管，同時一次性重建組織缺損、吞嚥和發聲機能。術後經復健及追蹤2年後結果，病患在術後3週可開始嘗試用發聲管進行發聲。發聲效率由剛開始約80%達到幾近100%程度。最長發聲時間由開始的6秒進步到10秒。濕聲情形爲輕度，音調(pitch)爲中度降低，音量爲輕度變小。單次呼氣可說出的詞彙長度由最初的平均2個詞彙到平均5個詞彙。言語清晰度從通常聽得懂但須要面對面接觸，進步到大多時候聽得懂偶爾需重複的結果。目前病人疾病無復發現象，並使用發聲管作爲日常溝通的方式，可使用電話並於公開場合進行口語溝通。
並列摘要
Voice and speech restoration are important components of life quality in patient with hypopharyngeal cancer following ablative surgical intervention. There are several surgical reconstructive options for the tissue defect. Among those, radial forearm free flap (RFFF) is a promising one. A 59 year-old male diagnosed as advanced hypopharyngeal cancer, underwent total pharyngolaryngectomy and reconstructed with RFFF- accompanied phonation tube for one stage reconstruction both for tissue defect and voice reconstruction. Voice rehabilitation began 3 weeks postoperatively and regular follow-up continued for 2 years. Phonation efficacy improved from 70% to near 100% finally. The length of longest phonation time was 6 seconds initially to 10 seconds. Voice quality is mild wet voice, moderate pitch and mildly decreased loudness. With regard of the speech understandability, it is graded as at least understandable most of the time and occasional repetition is necessary for the listener. The numbers of word speaking per breath began with two words and finally up to five words in average. There is no evidence of cancer recurrence at present time. Phonation and speech via the phonation tube work well as a daily communicating tool.
延伸閱讀
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