Tracheoesophageal Puncture (Singer-Blom) による喉摘後音声獲得手術

抄録

In 1979, Singer and Blom reported an endoscopic tracheoesophageal puncture technique for secondary voice restoration after total laryngectomy. During the past two years, we have performed the tracheoesophageal puncture on 23 total laryngectomy patients. Fifteen and eight cases were categorized into primary and secondary method, respectively. Out of twenty-three patients, 18 (78%) acquired fluent and intelligible speech. First day of phonation after operation was at the thirty-second and third day in the primary and secondary method, respectively. Maximum phonation time was 14 second in average.
Phonatory function was evaluated in 12 cases. The results obtained were as followed.
1) The fundamental frequency of voice was low and the range of voice frequency was narrow compared to normal subjects.
2) The intensity of voice ranged from 62 to 88dB SPL.
3) Mean airflow rates were below 200ml/sec in almost cases.
4) Tracheal pressure and airway resistance of esophageal source were high compared to normal subjects.
5) Efficiency of voice ranged from 0.1×10^-4 to 2.3×10^-4.
Relative advantages to use tracheoesophageal speech were compared to conventional esophageal speech. A comparison of speech rehabilitation between Amatsu tracheoesophageal shunt operation and tracheoesophageal puncture technique was discussed.
The causes of unsatisfactory result in tracheoesophageal speech using voice prosthesis were divided into three groups: 1) loss of motivation, 2) inability to manage the prosthesis and 3) inability to divert air through the constructed pharynx due to pharyngeal stricture, which consists of thyreopharyngeal muscle and cricopharyngeal muscle.