Saha Asok K, Samaddar Saikat, Choudhury Avijit, Chaudhury Abir, Roy Nirmalya
Department of ENT, Medical College and Hospital Kolkata, 88, College Street, Kolkata, 700073 West Bengal India.
Krishnanagar Bhavan, 323 Naba Pally, Sector 4, Salt Lake, Kolkata, 700105 India.
Indian J Otolaryngol Head Neck Surg. 2017 Jun;69(2):239-243. doi: 10.1007/s12070-017-1108-3. Epub 2017 Mar 9.
Larynx is the second most common site for cancer in the upper aerodigestive tract. One of the dreaded complications following total laryngectomy has been pharyngo cutaneous fistula (PCF). PCF merits special attention due to its significant negative impact on the recovery process. Total laryngectomy profoundly alters speech. Effective voice restoration is essential for the rehabilitation of these patients. Inadequate consensus exists as to the best technique of pharyngeal repair to decrease incidence of PCF and ensure good quality voice following total laryngectomy. 21 patients were included in the study for total laryngectomy with trachea oesophageal voice prosthesis placement. Patients were randomised into 2 groups. Group A had their pharynx repaired in two layers and Group B had it done in three layers. Post operatively the patients were followed up for a period of 12 months to look for incidence of PCF. Subjective and objective evaluation of voice was done. 9.52% of patients developed PCF. All of the cases of PCF were in the group repaired in three layers. In cases with repair by two layers the mean Voice Handicap Index 10 (VHI 10) score was 19.27 and those with three layers pharyngeal repair was 23.20. Average maximum phonation time amongst the study population was 13.09. In three layers and two layers pharyngeal repair the average maximum phonation time was 12.56 and 13.58 respectively. Surgical repair of pharynx in two layers excluding the third layer of pharyngeal musculature reduces the chance of PCF. Two layers pharyngeal repair supplemented by cricopharyngeal myotomy led to significantly better voice outcome.
喉是上呼吸道消化道中第二常见的癌症发生部位。全喉切除术后令人恐惧的并发症之一是咽皮肤瘘（PCF）。由于其对恢复过程有重大负面影响，PCF值得特别关注。全喉切除术会深刻改变语音。有效的语音恢复对于这些患者的康复至关重要。关于减少PCF发生率并确保全喉切除术后有良好语音质量的最佳咽部修复技术，目前尚未达成充分共识。本研究纳入了21例行全喉切除术并放置气管食管发音假体的患者。患者被随机分为两组。A组采用两层修复咽部，B组采用三层修复。术后对患者进行了为期12个月的随访，以观察PCF的发生率。对语音进行了主观和客观评估。9.52%的患者发生了PCF。所有PCF病例均在三层修复组。两层修复病例的平均嗓音障碍指数10（VHI 10）评分为19.27，三层咽部修复病例的评分为23.20。研究人群的平均最长发声时间为13.09。在三层和两层咽部修复中，平均最长发声时间分别为12.56和13.58。不包括咽部肌肉第三层的两层咽部手术修复可降低PCF的发生几率。两层咽部修复辅以环咽肌切开术可显著改善语音效果。
