The Use of Voice Hood to Facilitate Approximation of Voice Tube and Tracheostoma in Laryngopharyngeal Reconstruction with Free Ileocolic Flap

迴盲游離皮瓣重建喉咽缺損術後，利用聲帽使聲管與氣切口吻合易於發聲

黃俊源(Chun-Yuan Huang) ； 陳宏基(Hung-Chi Chen) ； 陳煥棠(Samuel HT Chen) ； 楊文圭(Wen-Guei Yang) ； 馮冠明(Guan-Ming Feng)

《中華民國整形外科醫學會雜誌》 13卷4期 (2004/12) Pp. 211-220

https://doi.org/10.7096/JPSA.200412.0211

摘要

在全喉咽切除術後，病患無法講話並且必須透過永久的氣切口呼吸。無法發聲相當不便，甚至會令病患沮喪和個性改變。雖然下咽癌5年存活率只有30%，但聲音重建應該是外科醫生的目標。迄今，為重建發聲功能，人造發聲裝置和氣管食道穿刺法(TEP)是最簡單的方法。不過，它們仍然有很多的缺點和併發症。19名喉癌和下咽癌患者，在全喉咽切除術後，使用迴盲游離皮瓣成功地同時重建吞嚥和發聲功能。但是頸部皮膚常因放射治療而變硬，使得病人將聲管與氣切口吻合時發生困難。因此，在切除頸部變硬的皮膚之後，利用同側三角肌胸肌根莖皮瓣製造聲帽以利聲管與氣切口吻合。我們描述手術方法並且顯示令人滿意的結果。病患講話更讓人聽得懂，最大發聲時間(MPT)也增加。它的優點是方法簡單且極少併發症。

並列摘要

After total laryngopharyngectomy, patients are devoid of speech and must breathe through a permanent tracheostoma. Loss of the voice is inconvenient for patients; it even can cause depression and personality changes. Although the 5-year survival rate is only 30% for cancer of the hypopharynx, vocal reconstruction still should be the surgeon's goal for these patients. So far, artificial voice device and the tracheoesophageal puncture (TEP) with a voice prosthesis are the simplest procedures for voice function; however, there are still many disadvantages and complications of these speech prostheses. 19 patients with laryngeal or hypopharyngeal cancer after total laryngopharyngectomy had been treated with free ileocolic flaps for reconstruction of swallowing and voice function at the same time successfully. However radiation-induced contracture of the neck skin can cause difficulty in approximating the voice tube with the tracheostoma. For this reason, the voice hood created from ipsilateral pedicled deltopectoral flap after release of the contracture is under development. We describe the surgical technique and show satisfactory results. An intelligible speech can be produced and maximal phonation time (MPT) increased. This method has the advantage of being a simple procedure with few complications.

並列關鍵字

laryngopharyngectomy ； ileocolic flap ； tracheostoma ； voice tube ； voice hood