Kummer P, Chahoud M, Schuster M, Eysholdt U, Rosanowski F
Abteilung für Phoniatrie und Pädaudiologie, Universitätsklinikum Erlangen.
HNO. 2006 Apr;54(4):315-22. doi: 10.1007/s00106-005-1259-5.
Indwelling voice prostheses are state of the art for post-laryngectomy voice rehabilitation. The aim of this study was to identify the impact of radiation prior to tracheoesophageal puncture on success rate and complications.
We undertook a retrospective study of 145 patients who had undergone prosthetic voice restoration between 1990 and 2002 (Provox) and Provox2). Risks of functional failure and complications in 17 patients with previous radiation therapy were compared to those of 128 patients without such therapy.
Previous radiation increased not only the risk of functional failure by 2.9 (P=0.023), but also the risk of shunt-related complications such as aspiration around the prosthesis (1.51; P=0.046), widening of the shunt (2.32; P=0.014), esophageal (2.51; P=0.013) or tracheal (3.29; P=0.0023) dislocation of the prosthesis and spontaneous (2.51; P=0.047) or surgical closure (3.76; P=0.037) of the shunt.
Primary tracheoesophageal puncture during laryngectomy is recommended in cases without previous radiation therapy, especially when post-laryngectomy radiation is likely. In patients with previous radiation therapy, generally good success rates decrease, however, without absolute contraindication of tracheoesophageal puncture. These results may affect salvage surgery concepts.
植入式语音假体是喉切除术后语音康复的先进技术。本研究的目的是确定气管食管穿刺前放疗对成功率和并发症的影响。
我们对1990年至2002年间接受假体语音恢复治疗（使用Provox和Provox2）的145例患者进行了回顾性研究。将17例曾接受放疗患者的功能失败和并发症风险与128例未接受此类治疗的患者进行了比较。
既往放疗不仅使功能失败风险增加2.9倍（P = 0.023），还增加了与分流相关并发症的风险，如假体周围误吸（1.51；P = 0.046）、分流扩大（2.32；P = 0.014）、假体食管（2.51；P = 0.013）或气管（3.29；P = 0.0023）脱位以及分流自发（2.51；P = 0.047）或手术闭合（3.76；P = 0.037）的风险。
对于未接受过放疗的病例，尤其是可能进行喉切除术后放疗的情况，建议在喉切除术中进行一期气管食管穿刺。在曾接受放疗的患者中，总体成功率会降低，然而，气管食管穿刺并无绝对禁忌证。这些结果可能会影响挽救手术的理念。
