Maniglia A J, Lundy D S, Casiano R C, Swim S C
Department of Otolaryngology--Head and Neck Surgery, Case Western Reserve University, University Hospitals of Cleveland, OH.
Laryngoscope. 1989 May;99(5):489-91. doi: 10.1288/00005537-198905000-00004.
The tracheoesophageal (TE) fistula with a speech prosthesis has become the method of choice for vocal rehabilitation in many postlaryngectomy patients. Several modifications of the procedure have been described including primary TE puncture at the time of laryngectomy. Fear of increased risk of complications has kept the primary procedure from widespread usage. Our series of 95 TE fistula procedures from 1980 to 1988 revealed 33 to be primary and 62 secondary. Eighty-five percent (85%) (28 of 33) patients in the primary group achieved long-term satisfactory speech (1 year or more of follow-up). Complications occurred in 36% of this group of patients. The success rate for the secondary group was 69% (43 of 62), while the complication rate was 21%. There were no instances of death, sepsis, or mediastinitis associated with either primary or secondary TE fistula patients. It appears that the primary TE fistula can be performed as safely and effectively as the secondary procedure.
带语音假体的气管食管瘘已成为许多喉切除术后患者进行嗓音康复的首选方法。该手术有多种改良方法，包括在喉切除时进行一期气管食管穿刺。由于担心并发症风险增加，一期手术尚未广泛应用。我们1980年至1988年的95例气管食管瘘手术系列显示，33例为一期手术，62例为二期手术。一期手术组85%（33例中的28例）患者获得了长期满意的语音效果（随访1年或更长时间）。该组患者并发症发生率为36%。二期手术组成功率为69%（62例中的43例），而并发症发生率为21%。一期或二期气管食管瘘患者均未出现死亡、脓毒症或纵隔炎病例。看来一期气管食管瘘手术与二期手术一样安全有效。
