喉頭摘出、喉頭摘出術、喉頭切除

WordNet

surgical removal of part or all of the larynx (usually to treat cancer of the larynx)

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/08/12 00:20:05」(JST)

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Laryngectomy is the removal of the larynx and separation of the airway from the mouth, nose and esophagus. In a total laryngectomy the entire larynx is removed and in a partial laryngectomy only a portion is taken out. The laryngectomee breathes through an opening in the neck known as a stoma.^[1] This procedure is usually performed in cases of laryngeal cancer. However, many laryngeal cancer cases are now treated only with more conservative surgeries through the mouth or with radiation and/or chemotherapy; laryngectomy is performed when those treatments fail to conserve the larynx or there is sufficient destruction by the cancer that would prevent normal function once it is destroyed. Laryngectomy is also performed on individuals with other types of head and neck cancer^[2] or severe swallowing problems.

Uses

Laryngectomees number about 60,000 in the United States. Perhaps 10,000 laryngeal cancer cases are treated annually, but only about 3,000 people undergo the surgery each year. Because it is a relatively rare cancer and because the post-operative care is complex in achieving a functional result, laryngeal cancer patients should be treated at or at least consult a major federally designated cancer center, where the fields of surgery, radiology, chemotherapy, speech-language pathology are all available.

Most laryngeal cancers in the UK are glottic, meaning they start in the vocal cords within the larynx. Glottic cancers tend to be picked up at an early stage, as they cause a hoarse voice very quickly. About 90 out of every 100 people (90%) with T1 glottic cancers are cured with radiotherapy or surgery alone. Of those patients who fail radiotherapy, many will be cured with salvage surgery.^[3] Many surgeons are returning to the use of endoscopic surgery for such early cancers as the voice result is very good and comparable to that of radiation.

The airways and ventilation after laryngectomy

The anatomy changes after a laryngectomy. After a total laryngectomy, the individual is breathing through the stoma where the tracheostomy opens in the neck. There is no longer a connection between the trachea and the mouth and nose. These individuals are termed total neck breathers. After a partial laryngectomy, the individual breathes mainly through the stoma, but a connection still exists between the trachea and upper airways; these individuals are able to breathe air through the mouth and nose. They are therefore termed partial neck breathers. The extent of breathing through the upper airways in these individuals varies and a tracheostomy tube is present in many of them. Ventilation and resuscitation of total and partial neck breathers is through their stoma; however, in these individuals the mouth should be kept closed and the nose sealed to prevent air escape.^[4]

Voice replacement

Voice functions are generally replaced with a voice prosthesis placed in the tracheo esophageal puncture created by the surgeon. The voice prosthesis is a one-way air valve that allows air to pass from the lungs/trachea to the esophagus when the patient covers the stoma. The redirected air vibrates the esophageal tissue producing a hoarse voice in lieu of the larynx.^[5]

A second method is the use of an electrolarynx. An electrolarynx is an external device that is placed against the neck and creates vibration that the speaker then articulates. The sound has been characterized as mechanical and robotic.

A third method is called esophageal speech. The speaker pushes air into the esophagus and then pushes it back up, articulating speech sounds to speak. This method is time-consuming and difficult to learn and is seldom used by laryngectomees.^[6]

In animals

Laryngectomies may be applied to dogs as a debarking procedure.

References

^ "ACS :: Speech After Laryngectomy". Archived from the original on 2007-11-05. Retrieved 2007-12-05.
^ Brook I (February 2009). "Neck cancer: a physician's personal experience". Arch. Otolaryngol. Head Neck Surg. 135 (2): 118. doi:10.1001/archoto.2008.529. PMID 19221236.
^ http://www.cancerhelp.org.uk/type/larynx-cancer/treatment/statistics-and-outlook-for-cancer-of-the-larynx#overall
^ Brook I (June)|Medical intelligence article: Ventilation of neck breathers undergoing a diagnostic procedure or surgery. Anesth Analg. 114(6)1318-21. 2012
^ Brook I (July 2009). "A piece of my mind. Rediscovering my voice". JAMA 302 (3): 236. doi:10.1001/jama.2009.981. PMID 19602676.
^ Brown DH, Hilgers FJ, Irish JC, Balm AJ (July 2003). "Postlaryngectomy voice rehabilitation: state of the art at the millennium". World J Surg 27 (7): 824–31. doi:10.1007/s00268-003-7107-4. PMID 14509514.

UpToDate Contents

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1. 局所進行性（ステージⅢおよびⅣ）頭頚部癌の治療：咽頭および下咽頭 treatment of locoregionally advanced stage iii and iv head and neck cancer the larynx and hypopharynx
2. 頭頚部癌の長期生存者に対するアプローチの概要 overview of approach to long term survivors of head and neck cancer
3. 頭頸部癌患者の言語および嚥下リハビリテーション speech and swallowing rehabilitation of the patient with head and neck cancer
4. 早期（ステージIおよびII）の頭頸部癌の治療：喉頭 treatment of early stage i and ii head and neck cancer the larynx
5. 無喉頭言語リハビリテーション alaryngeal speech rehabilitation

English Journal

Mid-term results of frontovertical partial laryngectomy for early glottic carcinoma with anterior commissure involvement.

Nie C, Shen C, Hu H, Ma Y, Wu H, Xiang M.Author information Department of Otolaryngology & Head and Neck Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China.AbstractAbstract Conclusion: Frontovertical partial laryngectomy is useful for treatment of T1 and T2 glottic squamous cell carcinoma with anterior commissure involvement. Objective: To evaluate the efficiency of frontovertical partial laryngectomy for T1 and T2 glottic carcinoma with anterior commissure involvement. Methods: This was a retrospective review of 58 cases of glottic squamous cell carcinoma with anterior commissure involvement (T1, n = 28; T2, n = 30) that were treated by frontovertical partial laryngectomy between August 2000 and August 2010. Results: Postoperative pathology reports confirmed negative tumor margins in every case. All patients were followed postoperatively, with a median follow-up interval of 55 months. Three patients had local recurrence; there were no patients who had cervical or distant metastases. The 3-year local control rate was 94% according to life tables curves. There were no reports of laryngostenosis or dysphagia in any patients, and mean Voice Handicap Index (VHI) questionnaire scores were 32.9.
Acta oto-laryngologica.Acta Otolaryngol.2014 Feb 10. [Epub ahead of print]
Abstract Conclusion: Frontovertical partial laryngectomy is useful for treatment of T1 and T2 glottic squamous cell carcinoma with anterior commissure involvement. Objective: To evaluate the efficiency of frontovertical partial laryngectomy for T1 and T2 glottic carcinoma with anterior commissure in
PMID 24506297

Laryngeal cancer.

Tomeh C, Holsinger FC.Author information Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, California, USA.AbstractPURPOSE OF REVIEW: Treatment of laryngeal carcinoma continues to evolve, and whereas there was a transition from total laryngectomy to chemoradiation in response to the Veterans Affairs study and Radiation Therapy Oncology Group (RTOG) 91-11, recent data suggest the role of partial laryngectomy must be revisited.
Current opinion in otolaryngology & head and neck surgery.Curr Opin Otolaryngol Head Neck Surg.2014 Feb 5. [Epub ahead of print]
PURPOSE OF REVIEW: Treatment of laryngeal carcinoma continues to evolve, and whereas there was a transition from total laryngectomy to chemoradiation in response to the Veterans Affairs study and Radiation Therapy Oncology Group (RTOG) 91-11, recent data suggest the role of partial laryngectomy must
PMID 24504224

Well and intermediate differentiated laryngeal chondrosarcoma: toward conservative surgery?

Damiani V, Crosetti E, Rizzotto G, Camaioni A, Succo G.Author information ENT Department, San Giovanni-Addolorata Hospital, Rome, Italy, valerio_damiani@me.com.AbstractChondrosarcoma of the larynx is a relatively rare malignant tumor. In the world literature, only 600 cases of laryngeal chondrosarcoma (LCS) have been reported. It is the most frequent non-epithelial tumor of the larynx (0.07-2 % of all cancers), usually occurring on the cricoid. We present six cases of well-intermediate differentiated grade chondrosarcoma of the larynx, diagnosed between the fifth and seventh decades of life, in the absence of relevant risk factors. All cases were subjected to a conservative surgical approach, either endoscopic using remodeling transoral laser surgery, or open neck via a supratracheal partial laryngectomy (STL), sparing laryngeal function. All patients are free from recurrence with a minimum follow-up of 31 months. All were ultimately decannulated, are able to tolerate a quite normal diet and to speak satisfactorily. Conservative laryngeal surgery is effective because chondrosarcoma is often a low-grade tumor showing slow growth. The criteria for choosing the type of surgery was based on the age of the patient (elderly patient > favoring an endoscopic approach), on the rate of involvement of the cricoid and on the involvement of the cricoarytenoid joints (if possible to save a cricoarytenoid unit > favoring a STL). By extending the inferior limit of the resection to include a large part of the cricoid cartilage, supratracheal partial laryngectomies expanded the indications to some LCSs not involving the entire cricoid lamina sparing laryngeal function and avoiding the need for total laryngectomy.
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery.Eur Arch Otorhinolaryngol.2014 Feb;271(2):337-44. doi: 10.1007/s00405-013-2656-0. Epub 2013 Aug 23.
Chondrosarcoma of the larynx is a relatively rare malignant tumor. In the world literature, only 600 cases of laryngeal chondrosarcoma (LCS) have been reported. It is the most frequent non-epithelial tumor of the larynx (0.07-2 % of all cancers), usually occurring on the cricoid. We present six cas
PMID 23974330

Japanese Journal

失声患者を受け持った看護学生の学びの様相

後藤姉奈,吉田和枝,辻川真弓,犬丸杏里,坂口美和,小幡光子,Goto Shina,Yoshida Kazue,Tsujikawa Mayumi,Inumaru Anri,Sakaguchi Miwa,Obata Mitsuko
三重看護学誌 14(1), 19-28, 2012-03-15
… 事前学習やコミュニケーション方法についてイメージする等準備していた．また学生は失声患者とのコミュニケーションにおける困難な体験を通してあらためて患者との人間関係構築について学び, また失声患者の障害受容や生活の再構築に向けた援助を実体験するなかで発展的に学んでいた．The aim of the present study was to clarify the aspects of learning of nursing students in charge of patients suffering from aphonia due to total laryngectomy. …
NAID 120003994115