全喉咽切除术后带游离空肠重建术的留置语音假体植入术。
Indwelling voice prosthesis insertion after total pharyngolaryngectomy with free jejunal reconstruction.
作者信息
Fukushima Hirofumi, Kanazawa Takeharu, Kawabata Kazuyoshi, Mitani Hiroki, Yonekawa Hiroyuki, Sasaki Toru, Shimbashi Wataru, Seto Akira, Kamiyama Ryousuke, Misawa Kiyoshi, Asakage Takahiro
机构信息
Department of Head and Neck Surgery.
Tokyo Medical and Dental University Graduate School of Medicine, Division of Head and Neck Tokyo Japan.
出版信息
Laryngoscope Investig Otolaryngol. 2017 Jan 24;2(1):30-35. doi: 10.1002/lio2.63. eCollection 2017 Feb.
OBJECTIVES
Total pharyngolaryngectomy with free jejunal reconstruction is often performed in patients with hypopharyngeal carcinoma. However, postoperative speechlessness significantly decreases patient quality of life. We investigated whether Provox® insertion could preserve speech after total pharyngolaryngectomy with free jejunal reconstruction.
STUDY DESIGN
Retrospective chart review.
METHODS
A total of 130 cases of secondary Provox® insertions after total pharyngolaryngectomy with free jejunal reconstruction were analyzed. Communication outcomes were compared using the Head and Neck Cancer Understandability of Speech Subscale. Outcomes and complications associated with insertion site (jejunal insertion vs. esophageal insertion) and adjuvant irradiation therapy were also evaluated.
RESULTS
Provox® insertion had favorable communication outcomes in 102 cases (78.4%). Neither the insertion site nor irradiation affected the communication outcome. Complications were observed in 20 cases (15.4%). Local infection was the most common complication. Free jejunal insertion, in which the resection range was enlarged, had a lower complication rate than did esophageal insertion, and its complication rate was unaffected by previous irradiation. For all patients, the hospitalization duration and duration of speechlessness were 13.4 days and 14.6 months, respectively. Patients receiving jejunal insertions had a significantly shorter hospitalization duration than did those receiving esophageal insertions. Unlike Provox®2, Provox®Vega significantly reduced the complication rate to zero.
CONCLUSION
For jejunal inserson of a Provox® prosthetic, a sufficient margin can be maintained during total pharyngolaryngectomy and irradiation can be performed, and satisfactory communication outcomes were observed. Provox® insertion after total pharyngolaryngectomy with free jejunal reconstruction should be considered the standard therapy for voice restoration.
LEVEL OF EVIDENCE
目的
下咽癌患者常行全喉咽切除术并游离空肠重建术。然而，术后失语显著降低患者生活质量。我们研究了植入Provox®能否在全喉咽切除术并游离空肠重建术后保留言语功能。
研究设计
回顾性病历审查。
方法
分析130例全喉咽切除术并游离空肠重建术后二期植入Provox®的病例。使用头颈癌言语可理解性子量表比较沟通结果。还评估了与植入部位（空肠植入与食管植入）及辅助放疗相关的结果和并发症。
结果
102例（78.4%）患者植入Provox®后沟通结果良好。植入部位和放疗均未影响沟通结果。20例（15.4%）出现并发症。局部感染是最常见的并发症。切除范围扩大的游离空肠植入并发症发生率低于食管植入，且其并发症发生率不受既往放疗影响。所有患者的住院时间和失语时间分别为13.4天和14.6个月。接受空肠植入的患者住院时间明显短于接受食管植入的患者。与Provox®2不同，Provox®Vega显著降低并发症发生率至零。
结论
对于Provox®假体的空肠植入，全喉咽切除术中可保持足够的切缘并可进行放疗，且观察到满意的沟通结果。全喉咽切除术并游离空肠重建术后植入Provox®应被视为恢复嗓音的标准治疗方法。
证据级别
4级。
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