Department of Plastic & Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
J Plast Reconstr Aesthet Surg. 2011 Jul;64(7):911-20. doi: 10.1016/j.bjps.2010.11.019. Epub 2011 Jan 13.
Total pharyngolaryngectomy (PL) reconstruction with an ileocolon free flap not only restores swallowing but also provides potential for speech. We report our surgical technique, functional outcome and quality of life (QoL) of 17 (15 males and two females) patients who underwent total PL/voice reconstruction with an ileocolon free flap between 2004 and 2009. The patients were retrospectively reviewed and swallowing, speech and QoL evaluated. Speech intelligibility was assessed using Hirose and Chen scoring systems, in addition to sound spectrogram analysis. QoL was evaluated using the European Organisation for Research and Treatment of Cancer Core Questionnaire (EORTC QLQ-C30) in conjunction with the disease-specific Head & Neck Cancer Module (QLQ-H&N35). The mean age of patients was 49 (range 35-69) years and the mean follow-up period was 22 (range 6-72) months. There was one partial flap failure and another flap was successfully salvaged. Swallowing function was achieved by 16 (94%) patients at 4 weeks, whilst 12 (71%) demonstrated moderate-to-excellent speech intelligibility. There were no cases of aspiration pneumonia. QLQ-C30 global QoL and functional subscales indicated patients had average-to-good functioning. Comparison of QLQ-H&N35 scores with EORTC reference values indicated our patients had greater difficulty with social contact, mouth opening and weight gain. Total PL/voice reconstruction with the ileocolon free flap is a viable option in selected patients, who desire autologous voice reconstruction. A low complication rate and reasonable QoL support this reconstructive method.
全咽喉切除术（PL）重建采用回结肠游离皮瓣不仅可以恢复吞咽功能，还可以为患者提供潜在的言语功能。我们报告了 2004 年至 2009 年间 17 例（15 名男性和 2 名女性）接受全 PL/嗓音重建术的患者的手术技术、功能结果和生活质量（QoL）。回顾性分析了患者的吞咽、言语和 QoL，并评估了语音清晰度。使用 Hirose 和 Chen 评分系统以及声谱图分析评估语音清晰度。使用欧洲癌症研究与治疗组织核心问卷（EORTC QLQ-C30）与特定疾病的头颈部癌症模块（QLQ-H&N35）联合评估 QoL。患者的平均年龄为 49 岁（范围 35-69 岁），平均随访时间为 22 个月（范围 6-72 个月）。有 1 例皮瓣部分坏死，另 1 例皮瓣成功挽救。16 例（94%）患者在 4 周时成功恢复吞咽功能，12 例（71%）患者的言语清晰度为中度至良好。无吸入性肺炎病例。QLQ-C30 总体 QoL 和功能子量表表明患者的功能处于平均至良好水平。与 EORTC 参考值比较 QLQ-H&N35 评分表明，我们的患者在社会接触、张口度和体重增加方面存在更大的困难。在选择希望进行自体嗓音重建的患者中，采用回结肠游离皮瓣进行全 PL/嗓音重建是一种可行的选择。低并发症发生率和合理的 QoL 支持这种重建方法。
