全喉切除术后气管食管瘘的扩大：系统评价和荟萃分析。
Enlarged tracheoesophageal puncture after total laryngectomy: a systematic review and meta-analysis.
机构信息
Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
出版信息
Head Neck. 2011 Jan;33(1):20-30. doi: 10.1002/hed.21399.
BACKGROUND
Enlargement of the tracheoesophageal puncture (TEP) is a challenging complication after laryngectomy with TEP. We sought to estimate the rate of enlarged puncture, associated pneumonia rates, potential risk factors, and conservative treatments excluding complete surgical TEP closure.
METHODS
A systematic review was conducted (1978-2008). A summary risk estimate was calculated using a random-effects meta-analysis model.
RESULTS
Twenty-seven peer-reviewed manuscripts were included. The rate of enlarged puncture and/or leakage around the prosthesis was reported in 23 articles (range, 1% to 29%; summary risk estimate, 7.2%; 95% confidence interval [CI], 4.8% to 9.6%). Temporary removal of the prosthesis and TEP-site injections were the most commonly reported conservative treatments. Prosthetic diameter (p = .076) and timing of TEP (p = .297) were analyzed as risk factors; however, radiotherapy variables were inconsistently reported.
CONCLUSION
The overall risk of enlarged puncture seems relatively low, but it remains a rehabilitative challenge. Future research should clearly establish risk factors for enlarged puncture and optimal conservative management.
背景
气管食管造口（TEP）扩大是喉切除术后 TEP 的一个具有挑战性的并发症。我们旨在评估扩大造口的发生率、相关肺炎发生率、潜在的危险因素以及除完全手术 TEP 闭合外的保守治疗。
方法
进行了系统评价（1978 年至 2008 年）。使用随机效应荟萃分析模型计算了汇总风险估计值。
结果
纳入了 27 篇同行评审的文献。23 篇文章报道了扩大造口和/或假体周围漏的发生率（范围为 1%至 29%；汇总风险估计值为 7.2%；95%置信区间[CI]为 4.8%至 9.6%）。临时移除假体和 TEP 部位注射是最常报道的保守治疗方法。假体直径（p =.076）和 TEP 时机（p =.297）被分析为危险因素；然而，放疗变量的报道不一致。
结论
总的来说，扩大造口的风险似乎相对较低，但仍是康复治疗的一个挑战。未来的研究应该明确确定扩大造口的危险因素和最佳的保守治疗方法。
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