Sittitrai P, Srivanitchapoom C, Reunmakkaew D
Department of Otolaryngology,Chiang Mai University Hospital,Thailand.
Otolaryngology Unit,Phayao Hospital,Thailand.
J Laryngol Otol. 2018 Mar;132(3):246-251. doi: 10.1017/S0022215118000178.
This study aimed to evaluate the impact of an onlay pectoralis major flap in reducing the incidence of pharyngocutaneous fistula after salvage total laryngectomy and determine the complications of pectoralis major flap reconstruction.
A retrospective study was conducted of consecutive patients who underwent salvage total laryngectomy between 1995 and 2016. The pharyngeal defects were primarily closed with or without the pectoralis major flap.
Of 64 patients, 34 had primary pharyngeal closure alone (control group) and 30 received an onlay pectoralis major flap (pectoralis major flap group). The overall fistula rate was 15.6 per cent, with 17.6 per cent occurring in the control group and 13.3 per cent in the pectoralis major flap group (p = 0.74). The incidence rates of voice failure (p = 0.02) and shoulder disability (p < 0.001) were significantly higher in the pectoralis major flap group.
The pectoralis major flap in salvage total laryngectomy did not decrease the pharyngocutaneous fistula rate, and the incidence of flap-related complications was high. Appropriate surgical technique and post-operative care may reduce the incidence of pharyngocutaneous fistula.
本研究旨在评估带蒂胸大肌肌皮瓣在挽救性全喉切除术后降低咽瘘发生率方面的作用，并确定胸大肌肌皮瓣重建的并发症。
对1995年至2016年间连续接受挽救性全喉切除术的患者进行回顾性研究。咽缺损主要采用或不采用胸大肌肌皮瓣进行封闭。
64例患者中，34例仅行一期咽闭合术（对照组），30例接受带蒂胸大肌肌皮瓣修复（胸大肌肌皮瓣组）。总体瘘发生率为15.6%，对照组为17.6%，胸大肌肌皮瓣组为13.3%（p = 0.74）。胸大肌肌皮瓣组的语音功能障碍发生率（p = 0.02）和肩部功能障碍发生率（p < 0.001）显著更高。
挽救性全喉切除术中使用胸大肌肌皮瓣并未降低咽瘘发生率，且皮瓣相关并发症发生率较高。适当的手术技术和术后护理可能会降低咽瘘的发生率。
