喉摘後の音声再建-TEシャントの新しい展開-

Abstract

During the past 14 years the tracheoesophageal (TE) shunt capability has been performed on 207 patients for primary voice restoration following total laryngectomy, and 172 patients (83%) retained fluent and intelligible speech with TE shunt. On the basis of successful results of postlaryngectomy speech with the TE shunt operation, the acquirement of both TE and esophageal speech, the primary tracheojejunal (TJ) shunt operation following pharyngolaryngoesophagectomy and the TE puncture operation for primary or secondary voice restoration reported by Singer and Blom were performed.Out of 172 patients who had TE speech, 8 obtained voice capability with esophageal speech and the vibratory source during phonation with esophageal voice was located at the hypopharynx as well as with TE speech. These indicated that the TE speakers could acquire the esophageal voice.The primary TJ shunt operation was performed on 6 patients for voice restoration following pharyngolaryngoesophagectomy with free jejunum reconstruction for advanced hypopharyngeal cancer. A fistula was created between the membraneous tracheal flap and the lower part of the transplanted jejunum. The membraneous part of the trachea was tubed to construct the TJ shunt. Out of 6 patients, 5 retained phonatory function. No leakage was seen at all during deglutition and a swallowing function was obtained in all 6 patients.A total of 29 patients underwent the TE puncture operation. Seventeen and twelve were performed for primary and secondary voice restoration after total laryngectomy, respectively. Out of 29 patients, 24 acquired fluent speech with voice prosthesis.