Wolber Philipp, Schwarz David, Balk Matthias, Luckscheiter Nicola, Sommer Claudia, Gostian Antoniu-Oreste
Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Cologne, 50924, Cologne, Germany.
Department of Otolaryngology, Staedt. Kliniken Neuss, Neuss, Germany.
Eur Arch Otorhinolaryngol. 2018 May;275(5):1281-1287. doi: 10.1007/s00405-018-4948-x. Epub 2018 Mar 24.
Pharyngeal fistula (PF) is one of the most common complications after total laryngectomy (TL). The tracheostoma plasty technique according to Herrmann (TPH) represents an alternative surgical technique to shape the tracheostoma. The aim of this study was to determine whether the performance of a TPH affects the incidence of PF after TL. A secondary aim was to identify potential risk factors for the development of PF with regard to TPH.
Retrospective evaluation of records of 151 consecutive patients at two tertiary care centers with regard to the occurrence and risk factors of PF after TL with and without TPH.
60 patients with TPH and 91 patients without TPH contributed to the results. The overall incidence of PF was 21.2% (32 out of 151). 23.3% (14 out of 60) of patients with TPH and 19.8% (18 of 91) of patients without TPH developed a PF (p = 0.91). Binary logistic regression analysis revealed significant influence of salvage surgery on the risk to develop PF (odds ratio = 2.9; 95% CI 1.16-7.23; p = 0.026). The occurrence of PF was not significantly influenced by any other investigated factors including performance of TPH.
Performance of TPH after TL does not increase the incidence of PF. Thus, TPH can be considered as a safe alternative surgical technique for the shaping of the tracheostoma following TL.
咽瘘（PF）是全喉切除术（TL）后最常见的并发症之一。根据赫尔曼（Herrmann）的气管造口成形术技术（TPH）是一种用于塑造气管造口的替代手术技术。本研究的目的是确定TPH的实施是否会影响TL后PF的发生率。第二个目的是确定与TPH相关的PF发生的潜在危险因素。
回顾性评估两个三级护理中心151例连续患者的记录，这些患者接受了有或没有TPH的TL后PF的发生情况和危险因素。
60例接受TPH的患者和91例未接受TPH的患者纳入结果分析。PF的总体发生率为21.2%（151例中的32例）。接受TPH的患者中有23.3%（60例中的14例）发生PF，未接受TPH的患者中有19.8%（91例中的18例）发生PF（p = 0.91）。二元逻辑回归分析显示挽救性手术对发生PF的风险有显著影响（优势比 = 2.9；95% CI 1.16 - 7.23；p = 0.026）。PF的发生不受任何其他研究因素的显著影响，包括TPH的实施情况。
TL后实施TPH不会增加PF的发生率。因此，TPH可被视为TL后塑造气管造口的一种安全的替代手术技术。
