University Hospitals Cleveland Medical Center, Department of Otolaryngology-Head and Neck Surgery, United States of America.
University Hospitals Cleveland Medical Center, Department of Otolaryngology-Head and Neck Surgery, United States of America.
Am J Otolaryngol. 2019 Nov-Dec;40(6):102272. doi: 10.1016/j.amjoto.2019.08.003. Epub 2019 Aug 2.
Previous research has demonstrated the safety of tracheoesophageal puncture voice prosthesis (TEP) placement in radiated patients; however, there is a growing population of twice-radiated patients with limited research on the outcomes of TEP-placement in this cohort.
After Institutional Review Board approval, a retrospective review of 80 patients that underwent TEP from 2006 to 2017 at a single institution was conducted, of which 16 patients underwent two courses of radiation. Outcome measures include TEP removal, complication and duration of usage.
Half of twice-radiated patients had ultimate removal of their voice prosthesis with removal occurring at a median of 24.9 months after placement. Reasons for prosthesis removal included widening tracheoesophageal fistula, local recurrence, and dysphagia/esophageal stenosis. Nearly one-third of these patients required surgical intervention for closure of a widening fistula. In contrast, only 17% of once-radiated patients had their prosthesis removed with removal occurring at a median of 28.1 months. This was statistically fewer than the twice-radiated group (p = 0.02). Reasons for removal included patient preference, persistent leakage, recurrence of disease, enlarging tracheoesophageal fistula, poor voice, and dysphagia. Eleven percent of once-radiated patients required surgical intervention for TEP-related complications (p = 0.057).
In the twice-radiated patient cohort, there is a higher rate of TEP removal and need for surgical intervention for a voice prosthesis-related complication as compared to a once-radiated cohort.
既往研究已经证实了放射性治疗患者行气管食管造瘘管（TEP）置管的安全性；然而，越来越多的患者经历了两次放射性治疗，对于这部分患者，TEP 置管的结果相关研究却很少。
在获得机构审查委员会批准后，我们对单中心 2006 年至 2017 年间 80 例行 TEP 治疗的患者进行了回顾性分析，其中 16 例患者经历了两次放射治疗。评估指标包括 TEP 管移除、并发症以及使用时长。
一半的二次放疗患者最终移除了他们的声管，在置管后 24.9 个月中位数时发生。移除的原因包括气管食管瘘管增宽、局部复发和吞咽困难/食管狭窄。近三分之一的患者需要手术干预以关闭增宽的瘘管。相比之下，只有 17%的单次放疗患者移除了他们的声管，在置管后 28.1 个月中位数时发生。这与二次放疗组相比明显更少（p=0.02）。移除的原因包括患者偏好、持续漏液、疾病复发、气管食管瘘管增宽、声音不佳和吞咽困难。11%的单次放疗患者因 TEP 相关并发症需要手术干预（p=0.057）。
与单次放疗组相比，二次放疗组 TEP 移除率和因声管相关并发症而需要手术干预的比例更高。
