Hilgers Frans J M, Soolsma Jessica, Ackerstaff Annemieke H, Balm Fons J M, Tan I Bing, van den Brekel Michiel W M
Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Laryngoscope. 2008 Apr;118(4):640-5. doi: 10.1097/MLG.0b013e31816067d5.
Assessment of the immediate results and long-term clinical effects of a thin silicone washer placed behind the tracheal flange of voice prostheses to treat periprosthetic leakage.
Three year retrospective analysis of 32 laryngectomized patients with 107 periprosthetic leakage events (PLEs). Custom-made silicone washers (outer diameter 18 mm, inner diameter 7.5 mm, thickness 0.5 mm) were placed behind the tracheal flange either in combination with prosthesis replacement or later.
There was immediate resolution of periprosthetic leakage in 88 PLEs (median, 38 d; mean, 53 d; range, 8-330 d) and in 6 PLEs with the washer still in situ at the date of analysis (median, 75; mean, 97 d; range, 38-240 d). There was no resolution for periprosthetic leakage in 13 PLEs. Thus, in total, 94 of 107 PLEs (88%) were successfully resolved. In 29 of 32 (91%) patients, the washer resolved the problem at least in one PLE successfully. Twelve of 32 patients, including all 3 with washer failures, also required other interventions to ultimately solve the problem. The vast majority of patients (80%) did not consider placement of the washer to be inconvenient.
In consideration of the high success rate and limited inconvenience for patients, this simple thin silicon washer application provides a good first option for the treatment of periprosthetic leakage.
评估置于发音假体气管凸缘后方的薄硅胶垫圈治疗假体周围渗漏的即时效果和长期临床疗效。
对32例喉切除患者的107次假体周围渗漏事件进行为期三年的回顾性分析。定制的硅胶垫圈（外径18毫米，内径7.5毫米，厚度0.5毫米）置于气管凸缘后方，可与假体更换同时进行或稍后进行。
88次假体周围渗漏事件得到即时解决（中位数为38天；平均数为53天；范围为8 - 330天），6次假体周围渗漏事件在分析时垫圈仍在位（中位数为75天；平均数为97天；范围为38 - 240天）。13次假体周围渗漏事件未得到解决。因此，107次假体周围渗漏事件中共有94次（88%）成功解决。32例患者中有29例（91%），垫圈至少成功解决了一次假体周围渗漏问题。32例患者中有12例，包括所有3例垫圈使用失败的患者，还需要其他干预措施才能最终解决问题。绝大多数患者（80%）认为放置垫圈并不不便。
鉴于成功率高且对患者不便程度有限，这种简单的薄硅胶垫圈应用为治疗假体周围渗漏提供了一个很好的首选方案。
