Phonation Reconstruction And Function Analysis After Total And Near-total Laryngectomy

Objects: Laryngeal and hypopharyneal carcinoma are themost common tumors of otolaryngology. The operativeamputate is still the first choice in laryngeal and hypopharynealcarcinoma treatment. But post-operative voice lose is stillchallenge for head and neck surgeon. Many methods aboutponation reconstruction have been recommended, but only feware refered to the ponation rehilitition at home and abroad. We analyzed retrospectively the condition ofpost-operative phonation reconstruction, the tracheo-esophagealshunt (modified Amatsu) and tracheo-hypopharyneal (modifiedPearson) that was designed by ourself. We also investigated thefunction of the phonation rehabilitition by Jiyan classifiedmethod, acouicis assessment, electroglottography and maximumphonation time, compared with the vertical hemilarygectomyand normal person. Methods: All objects were completely chosen from thepatients with laryngeal and hypopharyneal carcinoma undergonephonation reconstrucion in otolaryngology department of theforth hospital of the Hebei Medical University from December1996 to February 2004. Mofidied Pearson or modified Amatsuoperations are given respectively . According to the results of 4英 文 摘 要phonation rehabilitation and follow-up, we have maken clinicalanalysis. Otherwise, we chose randomly 30 patient with laryngealand hypopharyneal carcinoma obtained phonation rehabilition.Involving, 12 patients were performed modified Pearson and 18patients were performed modified Amatsu. And they werecompared with vertical hemilarygectomy (VHL) and normalperson. They were analyzed respectively by acouse analysis,electroglottography, maximun phonation time and Jiyanclassified method. Results: (1) The follow-up results. There were 43 patientsundergone modified Pearson and 26 patients undergonemodified Amatsu together. Obvious aspiration was not beenfound in modified Pearson group. But 10 patients have thecomplication of aspirations in modified Amatsu group.Post-operative radiotherapies are given in 5 cases together.Involving, 4 cases obtained phonation reconstructions inmodified Pearson group. But 1 patient undergone modifiedAmatsu failed. 37 patients in modified Pearson group and 22patients in modified Amatsu group obtained phonationrehabilitions less than one year after operation. There was nophonation failure case more than one year. The five yearssurvival rate is 4/5 in modified Pearson group. There is nopatient in modified Amatsu in five years. (2) Acouse analysis.Modified Pearson was close to modified Amatsu in thefundamental frequency and close to VHL and normal person. 5英 文 摘 要The jitter, shimmer, noise energy and harmonic noice rate (HNR)of modified Pearson and modified Amatsu increased. ModifiedAmatsu increased more obviously. They were close to VHL. (3)Electroglottography. The fundamental frequency, jitter,shimmer and noise energy of modified Pearson and modifiedAmatsu increased and were close to VHL. But HNR of modifiedPearson and modified Amatsu were close to VHL and normalperson. (4) Maximum phonation time. The Maximumphonation time of modified Pearson was close to modifiedAmatsu and less obviously than VHL and normal person. (5)Jiyan classified method. The fluent degree, loud degree,intelligible degree, acceptable degree and total score of modifiedPearson were close to modified Amatsu. But they were less thanVHL and normal person. Conclusions: We analyzed retrospectively the near-totallaryngotomy (modified Pearson) and tracheo- esophageal shunt(modified Amatsu) about laryngeal and hypopharynealcarcinoma treatment. And the phonation functions was analysedby acousic analysis, electroglottography, maximum phonatintime and Jiyan classified method.1. The successful rates of modified Pearson and modified Amatsu are respectively 86.1% and 84.6%. And they are safe and reliable. T...