Gehrking E
Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
HNO. 2010 May;58(5):497-505. doi: 10.1007/s00106-010-2085-y.
Tracheoesophageal (TEF) and tracheopharyngeal fistulas (TPF) after laryngectomy can mainly be divided into five types: "high TEF with leakage through the voice prosthesis (VP)" (Type Ia), "high TEF with leakage around the VP" (Type Ib), "enlarged high TEF" (Type II), "deep TEF" (Type III), "TPF" (Type IV) and "TPF associated with pharynx stenosis" (Type V). Leakage of TEF in prosthetic voice restoration usually responds well to conservative measures. If these measures fail, as well as in all cases of TPF, surgical intervention is necessary for transtracheostomal or transcervical closure with multi-layer sutures of the esophagus and trachea. In persisting TEF/TPF after unsuccessful surgical attempts revision surgery remains challenging. Tracheostoma transposition for dissociation of the cranial end of the trachea and the hypopharynx and esophagus is essential for effective closure. In rare cases of TPF combined with pharyngoesophageal stricture formation a resection and immediate reconstruction of the stenotic pharyngoesophageal segment with a tube-shaped fasciocutaneous radial forearm flap must be considered.
喉切除术后气管食管瘘（TEF）和气管咽瘘（TPF）主要可分为五种类型：“经发音假体（VP）渗漏的高位TEF”（Ia型）、“VP周围渗漏的高位TEF”（Ib型）、“扩大的高位TEF”（II型）、“深部TEF”（III型）、“TPF”（IV型）以及“与咽狭窄相关的TPF”（V型）。假体语音恢复中TEF的渗漏通常对保守措施反应良好。如果这些措施失败，以及在所有TPF病例中，手术干预对于经气管造口或经颈闭合食管和气管的多层缝合是必要的。在手术尝试失败后持续存在的TEF/TPF中，翻修手术仍然具有挑战性。气管造口移位以分离气管头端与下咽和食管对于有效闭合至关重要。在罕见的TPF合并咽食管狭窄形成的病例中，必须考虑用管状桡侧前臂筋膜皮瓣切除并立即重建狭窄的咽食管段。
