全喉切除术后一期气管食管穿刺的全国趋势。
National trends in primary tracheoesophageal puncture after total laryngectomy.
作者信息
Sethi Rosh K V, Deschler Daniel G
机构信息
Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.
Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A.
出版信息
Laryngoscope. 2018 Oct;128(10):2320-2325. doi: 10.1002/lary.27066. Epub 2017 Dec 27.
OBJECTIVES/HYPOTHESIS: Tracheoesophageal puncture (TEP) can be performed at the time of laryngectomy (primary) or postoperatively (secondary). Prior studies demonstrate safe and earlier voice acquisition and rehabilitation with primary TEP. The objectives of this study were to assess national trends in primary TEP and identify factors associated with its use.
STUDY DESIGN
Retrospective review.
METHODS
Retrospective analysis of the Nationwide Inpatient Sample (NIS) from 2010 to 2014 was performed. The NIS was queried for patients who underwent total laryngectomy (TL) (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] 30.3-30.4) and primary TEP (ICD-9-CM 31.95). Patient demographics, comorbidities, and factors known to influence the decision to perform TEP were characterized. Factors associated with primary TEP were identified by multivariable regression.
RESULTS
A total of 15,410 patients underwent TL during the study period. Of this cohort, 1,124 patients (7.3%) underwent primary TEP. Among patients who underwent primary TEP, 80.9% had laryngeal cancer, 16.4% had pedicled or free-flap reconstruction at the time of TL, 4.2% underwent partial pharyngectomy, and 48.0% underwent cricopharyngeal myotomy (CPM). The majority of primary TEPs were performed at urban teaching hospitals (90.6%). In multivariable regression, patients who underwent CPM were at significantly increased odds of primary TEP (odds ratio: 3.79, P < .0001). Flap reconstruction, partial pharyngectomy, age, gender, history of laryngeal cancer, hospital region, and teaching status were not associated.
CONCLUSIONS
Primary TEP is associated with earlier voice restoration after TL but is infrequently performed. The majority of primary TEPs are performed in teaching hospitals, and primary TEP is associated with concurrent cricopharyngeal myotomy. Future studies should investigate practice patterns associated with primary TEP.
LEVEL OF EVIDENCE
- Laryngoscope, 128:2320-2325, 2018.
目的/假设：气管食管穿刺（TEP）可在喉切除术时（一期）或术后（二期）进行。既往研究表明一期TEP能实现安全且更早的发声恢复和康复。本研究的目的是评估一期TEP的全国趋势，并确定与其使用相关的因素。
研究设计
回顾性研究。
方法
对2010年至2014年全国住院患者样本（NIS）进行回顾性分析。在NIS中查询接受全喉切除术（TL）（国际疾病分类第九版临床修订本[ICD - 9 - CM] 30.3 - 30.4）和一期TEP（ICD - 9 - CM 31.95）的患者。对患者的人口统计学特征、合并症以及已知影响TEP实施决策的因素进行描述。通过多变量回归确定与一期TEP相关的因素。
结果
在研究期间，共有15410例患者接受了TL。在该队列中，1124例患者（7.3%）接受了一期TEP。在接受一期TEP的患者中，80.9%患有喉癌，16.4%在TL时进行了带蒂或游离皮瓣重建，4.2%接受了部分咽切除术，48.0%接受了环咽肌切开术（CPM）。大多数一期TEP在城市教学医院进行（90.6%）。在多变量回归中，接受CPM的患者进行一期TEP的几率显著增加（比值比：3.79，P <.0001）。皮瓣重建、部分咽切除术、年龄、性别、喉癌病史、医院所在地区和教学状况与之无关。
结论
一期TEP与TL后更早的发声恢复相关，但实施频率较低。大多数一期TEP在教学医院进行，且一期TEP与同期环咽肌切开术相关。未来研究应调查与一期TEP相关的实践模式。
证据水平
4。《喉镜》，2018年，第128卷，第2320 - 2325页。
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