Erdim Ibrahim, Sirin Ali Ahmet, Baykal Bahadir, Oghan Fatih, Guvey Ali, Kayhan Fatma Tulin
Bakirkoy Sadi Konuk Education and Research Hospital, Department of ORL, Istanbul, Turkey.
Dumlupinar University, Faculty of Medicine, Department of ORL, Kutahya, Turkey.
Braz J Otorhinolaryngol. 2017 Sep-Oct;83(5):536-540. doi: 10.1016/j.bjorl.2016.06.011. Epub 2016 Jul 21.
Tracheoesophageal peristomal fistulae can often be solved by reducing the size of the fistula or replacing the prosthesis; however, even with conservative techniques, leakage around the fistula may continue in total laryngectomy patients. Also, several techniques have been developed to overcome this problem, including injections around the fistula, fistula closure with local flaps, myofascial flaps, or free flaps and fistula closure using a septal perforation silicon button.
To present the results of the application of silicon ring expanding the voice prosthesis in patients with large and persistent peri-prosthetic fistula.
A voice prosthesis was fitted to 42 patients after total laryngectomy. Leakage was detected around the prosthesis in 18 of these 42 patients. Four patients demonstrated improvement with conservative methods. Eight of 18 patients who couldn't be cured with conservative methods were treated by using primary suture closure and 4 patients were treated with local flaps. As silicon ring was applied as a primary treatment in the 2 remaining patients and also, applied to 2 patients who had recurrence after suture repair and to 2 patients who had recurrence after local flap implementation. Silicon rings were used in a total of 6 patients due to the secondary trachea-esophageal fistula. Patients were treated with provox-1 initially and later with provox-2. At the time of leakage around the fistula, 6 patients had provox-2.
Fistulae were treated successfully in 6 patients, and effective speech of patients was preserved. Patients experienced no adaptation problem. Prosthesis changing time was not different between silicon rings expanded and normal prosthesis applied patients. Silicon ring combined voice prosthesis was used 26 times; there was no recurrence in fistula complication during 29±6 months follow up.
Silicon rings for modified expanded voice prosthesis seems to be an effective treatment for persistent peri-prosthetic leakage, for both, fistula closure and preserving the patients speech.
气管食管造口瘘通常可通过缩小瘘口尺寸或更换假体来解决；然而，即便采用保守技术，全喉切除患者的瘘口周围仍可能持续渗漏。此外，已研发出多种技术来克服这一问题，包括在瘘口周围注射、用局部皮瓣、肌筋膜瓣或游离皮瓣关闭瘘口以及使用鼻中隔穿孔硅钮关闭瘘口。
介绍应用硅环扩张语音假体治疗大型持续性假体周围瘘患者的结果。
42例全喉切除术后患者安装了语音假体。这42例患者中有18例在假体周围检测到渗漏。4例患者采用保守方法后症状改善。18例无法通过保守方法治愈的患者中，8例接受了一期缝合关闭治疗，4例接受了局部皮瓣治疗。另外2例患者将硅环作为初始治疗方法，2例缝合修复后复发的患者以及2例局部皮瓣植入后复发的患者也应用了硅环。因继发性气管食管瘘，共有6例患者使用了硅环。患者最初使用Provox-1，之后使用Provox-2。在瘘口周围出现渗漏时，6例患者使用的是Provox-2。
6例患者的瘘口得到成功治疗，患者的有效语音得以保留。患者未出现适应问题。使用硅环扩张的患者与应用普通假体的患者在更换假体时间上并无差异。硅环联合语音假体共使用了26次；在29±6个月的随访期间，瘘口并发症未复发。
用于改良扩张语音假体的硅环似乎是治疗持续性假体周围渗漏的有效方法，可以关闭瘘口并保留患者语音。
