Seven Huseyin, Calis Asli Batur, Turgut Suat
Otorhinolaryngology Clinic, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.
Laryngoscope. 2003 Jun;113(6):1076-9. doi: 10.1097/00005537-200306000-00030.
To evaluate the safety and efficacy of early oral feeding by comparing it with feeding through primary tracheoesophageal puncture after total laryngectomy with primary pharyngeal closure.
A prospective, randomized, controlled study.
Patients who underwent total laryngectomy with primary pharyngeal closure and who were candidates for primary voice restoration (an in whose cases primary tracheoesophageal puncture [TEP] was created) were included. After total laryngectomy, patients were randomly assigned to either the oral group (study group) or the TEP group (control group). Patients in the oral group were fed orally with a clear liquid diet on the first postoperative day, then advanced to a regular diet, whereas patients in the TEP group were fed through tracheoesophageal puncture and received nothing orally until the seventh postoperative day; then they were fed orally if fistula had not occurred. Standard criteria for discharge were used for all the patients.
During a 3-year period, 67 patients were enrolled in the trial, and complete data were available for 65 patients (32 patients in the oral group, 33 patients in the TEP group). The two groups were similar for factors reported to influence the rate of pharyngocutaneous fistula. In three (9%) patients in the TEP group, fistula occurred on the 5th, 7th, and 14th postoperative days, respectively. Two (6.2%) fistulas occurred in the oral group on the sixth and eighth postoperative days, respectively. In patients without fistula, the mean length of hospital stay was 7.6 days (range, 4-19 d [SD = 3.1 d]) for the oral group and 8.2 days (range, 7-18 d [SD = 2.6 d) for the TEP group. There was no significant difference between two groups for either the incidence of fistula or the length of hospital stay.
Initiation of oral feeding on the first postoperative day in patients undergoing total laryngectomy with primary pharyngeal closure is a safe clinical practice. However, it does not shorten the length of hospital stay for these patients.
通过将全喉切除并一期咽闭合术后早期经口喂养与一期气管食管穿刺喂养进行比较，评估早期经口喂养的安全性和有效性。
一项前瞻性、随机对照研究。
纳入接受全喉切除并一期咽闭合且适合一期嗓音恢复（即已行一期气管食管穿刺[TEP]）的患者。全喉切除术后，患者被随机分为经口组（研究组）或TEP组（对照组）。经口组患者术后第1天开始经口给予清流质饮食，然后逐渐过渡到常规饮食，而TEP组患者通过气管食管穿刺喂养，术后第7天前不给予经口饮食；若未发生瘘，则术后第7天开始经口喂养。所有患者均采用标准出院标准。
在3年期间，67例患者纳入试验，65例患者有完整数据（经口组32例，TEP组33例）。两组在据报道影响咽皮肤瘘发生率的因素方面相似。TEP组有3例（9%）患者分别在术后第5天、第7天和第14天发生瘘。经口组有2例（6.2%）瘘分别发生在术后第6天和第8天。在无瘘的患者中，经口组平均住院时间为7.6天（范围4 - 19天[标准差 = 3.1天]），TEP组为8.2天（范围7 - 18天[标准差 = 2.6天]）。两组在瘘发生率或住院时间方面均无显著差异。
全喉切除并一期咽闭合术后患者术后第1天开始经口喂养是一种安全的临床做法。然而，这并未缩短这些患者的住院时间。
