本文選題：喉切除術(shù) + 言語　； 參考：《寧夏醫(yī)科大學(xué)》2010年碩士論文

【摘要】：目的全喉切除術(shù)后給患者帶來的最大痛苦是失去發(fā)音功能。術(shù)后最常見的發(fā)音方法是食管音、氣管食管造瘺發(fā)音和氣管食管造瘺安裝發(fā)音管發(fā)音,其成功率約為70%-80%;使用食管音助發(fā)聲器可提高發(fā)音成功率,發(fā)音的主觀評估已有報道,本研究通過客觀聲學(xué)分析來探討食管音助發(fā)聲器的發(fā)音質(zhì)量。方法本研究所選擇的實驗組病例來自1994年3月至2005年7月在寧夏醫(yī)科大學(xué)附屬醫(yī)院耳鼻咽喉-頭頸外科就診,診斷為喉癌,行全喉切除Blom-Singer術(shù)式發(fā)音重建患者共39例,其中健在24例,健在能聯(lián)系到并自愿配合檢查的僅此10例;安裝發(fā)音管不能發(fā)音的4例與安裝后能發(fā)音因長肉芽不得不去除發(fā)音管改用食管音助發(fā)聲器患者1例;共5例為食管音助發(fā)聲器組;安裝發(fā)音管能發(fā)音的5例做為氣管食管音組。選擇12名年齡基本匹配的無嗓音疾病的正常男性作為對照組。進行聲學(xué)參數(shù):基頻、頻率微擾、振幅微擾、諧噪比,最大發(fā)音實時間及聲強的檢測。結(jié)果1.食管音助發(fā)聲器發(fā)音組、氣管食管音組和正常嗓音組的基頻值分別為155.73Hz、147.52Hz和168.87Hz;食管音助發(fā)聲器發(fā)音組和氣管食管音組的基頻較正常嗓音組低,差異有統(tǒng)計學(xué)意義(P0.05),食管音助發(fā)聲器發(fā)音組與氣管食管音組的基頻差異無統(tǒng)計學(xué)意義(P0.05)。2.食管音助發(fā)聲器發(fā)音組、氣管食管音組和正常嗓音組的基頻微擾值分別為1.89%、1.85%和0.17%,振幅微擾值分別為6.74%、6.57%和1.70%,諧噪比值分別為10.97dB、10.27dB和21.19dB,食管音助發(fā)聲器發(fā)音組和氣管食管音組的基頻微擾及振幅微擾高于正常嗓音組,差異有顯著性(P0.01),但諧噪比低于正常人有顯著性差異(P0.01),食管音助發(fā)聲器發(fā)音組和氣管食管音組的基頻微擾、振幅微擾和諧噪比的差異無統(tǒng)計學(xué)意義(P0.05)。3.食管音助發(fā)聲器發(fā)音組、氣管食管音組和正常嗓音組的聲強值分別為77.40dB、76.85dB和83.30dB。與正常嗓音組相比,食管音助發(fā)聲器發(fā)音組和氣管食管音組的聲強與之沒有顯著差異(P0.05)。4.語譜圖顯示食管音助發(fā)聲器發(fā)音和氣管食管音較粗糙,聲音洪亮,發(fā)音清楚。5.食管音助發(fā)聲器發(fā)音組、氣管食管音組和正常嗓音組的最大發(fā)音時間分別為10.77秒、6.10秒和15.81秒。食管音助發(fā)聲器發(fā)音組和氣管食管音組最大發(fā)音時間低于正常嗓音組,有顯著性差異(P0.01),但一口氣音節(jié)數(shù)差異無統(tǒng)計學(xué)意義(P0.05)。食管音助發(fā)聲器發(fā)音的最大發(fā)音時間高于氣管食管音,差異有統(tǒng)計學(xué)意義(P0.05)。結(jié)論1.食管音助發(fā)聲器發(fā)音和氣管食管音患者基頻較正常人低,提示該兩組患者音調(diào)較正常人要低。2.食管音助發(fā)聲器發(fā)音和氣管食管音患者的基頻微擾及振幅微擾高于正常人,但諧噪比低于正常人,這說明與正常嗓音相比,食管音助發(fā)聲器發(fā)音和氣管食管發(fā)音的聲音更粗糙,且有較多噪音成分。3.與正常嗓音相比,食管音助發(fā)聲器發(fā)音和氣管食管音的聲強與之沒有顯著差異,提示平穩(wěn)發(fā)音的條件下聲強沒有差異。4.語譜圖顯示食管音助發(fā)聲器發(fā)音和氣管食管音音質(zhì)清晰,響度大,發(fā)音質(zhì)量較穩(wěn)定,音色較渾厚,表明基本上能夠滿足日常會話需要。5.食管音助發(fā)聲器發(fā)音和氣管食管音患者最大發(fā)音時間雖低于正常人,但一口氣音節(jié)數(shù)大多數(shù)己達I級,這表明食管音助發(fā)聲器發(fā)音患者能夠自如地運用聲音進行日常交流,不易出現(xiàn)發(fā)音管發(fā)音組中個別患者發(fā)音中中途無聲現(xiàn)象。食管音助發(fā)聲器發(fā)音組的最大發(fā)音時間高于氣管食管音組。說明食管音助發(fā)音器發(fā)音語音連貫性更好。通過以上結(jié)果,說明食管音助發(fā)聲器發(fā)音的聲音是較令人滿意的,對于無喉患者來說,尤其是發(fā)音重建安裝發(fā)音管發(fā)音失敗患者無疑是一種較好的聲音選擇。
[Abstract]:Objective the greatest pain for patients after total laryngectomy is to lose pronunciation. The most common method of pronunciation after operation is esophageal sound, tracheoesophageal fistula pronunciation and tracheoesophageal fistula installation of pronunciation tube pronunciation, the success rate is about 70%-80%; the use of esophageal sound aids can improve the success rate of pronunciation, the subjective assessment of pronunciation has been reported, In this study, objective acoustic analysis was used to investigate the sound quality of the esophageal sound aid. Methods the cases selected from this study were from March 1994 to July 2005 at the otorhinolaryngology head and neck surgery in the Affiliated Hospital of Ningxia Medical University, diagnosed as laryngectomy, and 39 cases of total laryngectomy were performed by Blom-Singer. In 24 cases, only 10 of them were able to contact and voluntarily cooperate with the examination; 4 cases of articulation tubes that could not be articulation and 1 patients who had to pronounce the sound tube to the sound tube after the installation had to be pronounced with long granulation had to be removed from the esophagus sound aid group; 5 cases were used as the esophageal sound aid group; 5 cases of articulation tube can be used as the tracheoesophageal sound group. Select 12. The acoustic parameters: basic frequency, frequency perturbation, amplitude perturbation, harmonic noise ratio, maximum sound time and sound intensity were measured. Results the basic frequency of 1. esophageal sound aid sound apparatus, tracheoesophageal sound group and normal voice group were 155.73Hz, 147.52Hz and 168.87Hz, respectively; The basic frequency of the sound and tracheoesophageal sound group was lower than that of the normal voice group (P0.05). There was no significant difference in the basal frequency between the sound group and the trachea of the trachea and esophagus (P0.05).2. esophageal sound aid sound apparatus, and the basal frequency perturbation of the trachea and the normal voice group were respectively the basic frequency perturbation values of the trachea and the normal voice group. 1.89%, 1.85% and 0.17%, the amplitude perturbation values were 6.74%, 6.57% and 1.70%, and the harmonic noise ratios were 10.97dB, 10.27dB and 21.19dB respectively. The basal frequency perturbation and the amplitude perturbation of the sound and tracheoesophageal sound group were higher than those of the normal voice group (P0.01), but the harmonic noise ratio was significantly different (P0.01), the esophagus was lower than the normal person (P0.01). The basic frequency perturbation of the sound and tracheoesophageal sound groups, the difference of the amplitude perturbation and the noise ratio is not statistically significant (P0.05).3. esophagus sound aid sound apparatus, the sound intensity of the tracheoesophageal sound group and the normal voice group is 77.40dB, 76.85dB and 83.30dB. are compared with the normal voice group, and the sound group and the Qi of the esophageal sound aid sound aid apparatus are compared with the normal voice group. The sound intensity of the esophageal sound group was not significantly different (P0.05).4. spectrum showed that the pronunciation of the esophageal sound aid and the tracheoesophageal sound were rough, the sound was bright, the pronunciation of the.5. esophagus sound aid sound apparatus was clear, the maximum pronunciation time of the trachea and esophagus sound group and the normal voice group was 10.77 seconds, 6.10 seconds and 15.81 seconds respectively. The maximum pronunciation time of the articulatory group and the trachea and esophagus group was lower than the normal voice group. There was a significant difference (P0.01), but the difference of one tone syllables was not statistically significant (P0.05). The maximum pronunciation time of the sound apparatus in the esophagus was higher than that of the trachea and esophagus (P0.05). Conclusion the pronunciation and trachea of the 1. esophagus sound aid sound apparatus and the trachea The basic frequency of the patients with esophageal sound is lower than that of the normal person, suggesting that the tone of the two groups of patients is lower than that of the normal person. The basic frequency and amplitude perturbation of the.2. esophageal sound aid and the tracheoesophageal sound are higher than those of the normal people, but the harmonic ratio is lower than that of the normal people, which shows that the sound of the esophagus sound and the sound of the tracheoesophageal pronunciation is compared with the normal voice. More rough and more noisy, compared with the normal voice, there was no significant difference between the sound and the sound of the trachea and esophagus, suggesting that there was no difference between the sound intensity of the esophageal sound aid and the tracheoesophageal sound, suggesting that there was no difference between the sound intensity of the sound and the sound quality of the trachea and esophagus, the sound quality of the esophagus, the sound sound quality, the sound sound quality, and the sound quality of.3.. The color of the.5. esophagus sounds and the tracheoesophageal sound is less than the normal person, but the number of the one tone syllables is I, which indicates that the patients with the sound of the sound are able to use the sound for daily communication, and the pronunciation tube is not easy to appear. A few patients in the pronunciation group have no sound in the middle of pronunciation. The maximum pronunciation time of the voice group of the esophageal sound AIDS is higher than that of the trachea and esophagus. It shows that the pronunciation of the esophageal sound AIDS is better. It is pronunciation reconstruction, installation of articulation tube, failure of voice is undoubtedly a better choice of voice.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R767

【參考文獻】

相關(guān)期刊論文 前10條

1 韓仲明;嗓音疾病的臨床檢測[J];國外醫(yī)學(xué)(耳鼻咽喉科學(xué)分冊);1998年05期

2 尚耀東,吳彥橋,趙國慶,陶振峰,白坤歧,湯曉義,李琦,趙超英,高蘭瑛;全喉切除發(fā)音重建術(shù)后喉咽部頸段食管影像學(xué)研究[J];北京軍區(qū)醫(yī)藥;1997年05期

3 胡連生,趙玉紅,楊式麟;嗓音頻率微擾的檢測及臨床意義[J];臨床耳鼻咽喉科雜志;1993年01期

4 彭玉成,陸書昌;選擇性咽縮肌切斷術(shù)在全喉切除術(shù)后發(fā)音重建中的作用[J];臨床耳鼻咽喉科雜志;1996年04期

5 衛(wèi)旭東,金國威,李少誠,張建新,陳杰,王軍;氣管食管裂隙狀發(fā)聲孔發(fā)聲機制研究[J];臨床耳鼻咽喉科雜志;2004年06期

6 高建中,馬瑞霞,劉懷濤,楊培,郭宏慶,高小平,邵輝,保國華;食管音氣流注入位置篩選與新發(fā)聲方式的研究[J];臨床耳鼻咽喉科雜志;2005年21期

7 楊青,徐文,侯麗珍,張麗;正常成人嗓音的計算機測試及定量分析[J];首都醫(yī)科大學(xué)學(xué)報;2005年02期

8 楊式麟;喉發(fā)聲功能檢查(續(xù)7)[J];聽力學(xué)及言語疾病雜志;2001年02期

9 肖淑芬,尚耀東,李曉明,李琦,賀銀芳;無喉者發(fā)不同元音時的聲學(xué)參數(shù)及氣管內(nèi)壓力比較[J];聽力學(xué)及言語疾病雜志;2004年04期

10 于萍,韓冰,楊偉炎,韓東一;不同性別嗓音客觀檢測參數(shù)的對比分析[J];聽力學(xué)及言語疾病雜志;2004年06期

，

本文編號：1972606