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Fundamental Study of Artificial Larynx after Larngeal Resection

喉切除术后人工喉的基础研究

基本信息

批准号：
02670762
负责人：
KOJIMA Hisayoshi
金额：
$ 1.34万
依托单位：
Kyoto University
依托单位国家：
日本
项目类别：
Grant-in-Aid for General Scientific Research (C)
财政年份：
1990
资助国家：
日本
起止时间：
1990 至 1991
项目状态：
已结题

项目摘要

Speech rehabilitation is important for the patients of laryngeal carcinoma after partial or total laryngectomy. The purpose of this research was to develop the new methods for speech rehabilitation and the new artificial larynx. At first, we analyzed the voice quality of the present methods after total laryngectomy. In esophageal speech, the intensity fluctuated widely and periodic vibration was obtained in few cases in contrast to tracheoesophageal shunt speech because the air flow was not enough for driving the mucosa of pharyngoesophageal segment. From these results, tracheoesophageal shunt speech with voice prostheses is one of the best method for vocal rehabilitate after total laryngectomy. We made it clear about the mechanism of vibration of tracheoesophageal shunt speech and devised the new surgical methods for improving the poor phonation cases.From the view points of voice quality, vocal control and articulation, tracheopharyngeal shunt speech was considered to be the best method. We made the reed-fistula type artificial larynx of which sound source was inserted through the skin-hypopharynx shunt. This device was applied for clinical use and good voice quality was obtained. It is necessary for us to improve it to be transplanted for long-term in human body.In partial laryngectomy, the key point is the reconstruction of the defect of the larynx. Thyroid gland flap, omohyoid muscle flap, and free mucosal transplantation were devised to correct the laryngeal defect. Utilization of the residual laryngeal function is also helpful for acquiring the good voice quality. Electrical pacing of the paralyzed vocal fold was performed successfully and dynamic reconstruction of the unilateral vocal fold paralysis was obtained clinically.These results were considered to contribute to vocal rehabilitation after partial and total laryngectomy of the patients of laryngeal carcinoma.

喉癌患者喉部分或全切除术后的语言康复治疗是非常重要的。本研究的目的是开发新的语音康复方法和新的人工喉。本文首先分析了目前喉全切除术后各种方法的嗓音质量。与气管食管分流术相比，食管发音时，由于气流不足以驱动咽食管段粘膜，强度波动较大，少数病例出现周期性振动。因此，气管食管分流术是喉全切除术后发音重建的最佳方法之一。本文阐明了气管食管分流术语音振动的机理，设计了改善发音不良病例的新手术方法，从语音质量、发声控制和清晰度等方面考虑，认为气管咽分流术语音效果最好。我们制作了经皮肤-下咽分流管插入声源的簧片-瘘管型人工喉。该装置已应用于临床，获得了良好的语音质量。喉部分切除术的关键是喉缺损的重建。采用甲状腺瓣、肩胛舌骨肌瓣及游离喉黏膜移植修复喉缺损。利用喉的残余功能也有助于获得良好的嗓音质量。成功地对麻痹的声带进行了电起搏，并在临床上获得了单侧声带麻痹的动态重建，为喉癌患者部分或全喉切除术后的发音重建提供了依据。