University of Toronto, Faculty of Medicine, Department of Otolaryngology - Head and Neck Surgery, 200 Elizabeth Street, 8th Floor 8NU 881, Toronto, Ontario, Canada M5G 2C4.
Head Neck. 2019 Jan;41(1):16-29. doi: 10.1002/hed.25192. Epub 2018 Dec 3.
Surgeons have developed various reconstructive techniques to minimize the rate of pharyngocutaneous fistula and optimize functional outcome after salvage laryngectomy or laryngopharyngectomy.
Multicenter retrospective review at 33 institutions of 486 patients with a history of squamous cell carcinoma (SCC) of the larynx or hypopharynx previously treated with primary chemoradiotherapy (CRT) who required salvage surgery. Outcomes evaluated were overall fistula rate, fistula requiring reoperation, and 12-month speech and swallowing function.
Primary closure of the hypopharynx was associated with a statistically higher overall fistula rate and fistula requiring reoperation compared to reconstruction with vascularized tissue augmentation. Vascularized tissue augmentation with muscle led to worse 12-month "understandability of speech" and "nutritional mode" scores compared to vascularized tissue augmentation without muscle.
Vascularized tissue augmentation reduces the overall fistula rate and fistula requiring reoperation but vascularized tissue augmentation with muscle may impair speech and swallowing outcomes.
外科医生已经开发出各种重建技术，以最大限度地降低咽皮瘘的发生率，并优化挽救性喉切除术或喉咽切除术的功能结果。
在 33 家机构对 486 例先前接受过原发性放化疗（CRT）治疗的喉或下咽鳞状细胞癌（SCC）患者进行了多中心回顾性研究，这些患者需要挽救性手术。评估的结果是总瘘管发生率、需要再次手术的瘘管，以及 12 个月时的言语和吞咽功能。
与血管化组织增强重建相比，原发性下咽闭合与更高的总瘘管发生率和需要再次手术的瘘管相关。与无肌肉的血管化组织增强相比，血管化组织增强伴肌肉导致 12 个月时“言语理解”和“营养模式”评分更差。
血管化组织增强可降低总瘘管发生率和需要再次手术的瘘管，但血管化组织增强伴肌肉可能会损害言语和吞咽功能。
