同步放化疗后挽救性全喉切除术中一期与二期气管食管穿刺的比较
Primary versus secondary tracheoesophageal puncture in salvage total laryngectomy following chemoradiation.
作者信息
Emerick Kevin S, Tomycz Luke, Bradford Carol R, Lyden Teresa H, Chepeha Douglas B, Wolf Gregory T, Teknos Theodoros N
机构信息
Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.
出版信息
Otolaryngol Head Neck Surg. 2009 Mar;140(3):386-90. doi: 10.1016/j.otohns.2008.10.018.
OBJECTIVE
To compare the rate of postoperative wound-healing complications and voice fluency in primary vs secondary tracheoesophageal puncture (TEP) following chemoradiation.
METHODS
Between 1998 and 2005, 30 patients underwent laryngectomy after chemoradiation therapy. Twenty patients underwent primary TEP and 10 patients underwent secondary TEP. Comorbidities, postoperative complications, speech fluency, and time to speech fluency were evaluated in each patient.
RESULTS
Pharyngocutaneous fistula (PCF) occurred in 10 of 20 (50%) patients who underwent primary TEP and in 0 of 10 (0%) patients in the secondary TEP group (P < 0.05). Overall, 25 of 25 (100%) patients who had placement of a tracheoesophageal prosthesis achieved fluent speech. Median time to fluency was 63 days in the primary TEP group and 125 days in the secondary TEP group.
CONCLUSION
There is an increased risk of PCF in patients undergoing primary TEP compared with secondary TEP following chemoradiation. No difference in acquisition of speech fluency was identified between the two groups. Patients undergoing primary TEP achieved fluent speech 62 days sooner than their secondary TEP counterparts.
目的
比较同步放化疗后一期与二期气管食管穿刺造瘘术（TEP）的术后伤口愈合并发症发生率及语音流畅度。
方法
1998年至2005年间，30例患者在同步放化疗后接受了喉切除术。20例行一期TEP，10例行二期TEP。对每位患者的合并症、术后并发症、语音流畅度及达到语音流畅度的时间进行评估。
结果
一期TEP组20例患者中有10例（50%）发生咽皮瘘（PCF），二期TEP组10例患者中无1例发生（0%）（P<0.05）。总体而言，25例植入气管食管假体的患者均实现了流畅语音。一期TEP组达到流畅语音的中位时间为63天，二期TEP组为125天。
结论
与同步放化疗后的二期TEP相比，一期TEP患者发生PCF的风险增加。两组在获得语音流畅度方面无差异。一期TEP患者比二期TEP患者早62天实现流畅语音。
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