Department of Otorhinolaryngology-Head and Neck Surgery, University of Erlangen, Nuremberg, Germany.
Department of Radiation Oncology, University of Erlangen, Nuremberg, Germany.
Laryngoscope. 2020 Dec;130(12):E865-E873. doi: 10.1002/lary.28517. Epub 2020 Feb 6.
OBJECTIVES/HYPOTHESIS: To evaluate the demographics, clinical features, management, and prognostic indicators of tracheoesophageal puncture complications in patients undergoing placement of voice prosthesis following cancer treatment.
Retrospective analysis.
A retrospective analysis was conducted of cases from a tertiary referral center diagnosed between 1996 and 2015. Multivariate logistic regression was used to determine factors associated with tracheoesophageal puncture (TEP) and voice prostheses-complication-free survival (TEP/VP-CFS).
One hundred fourteen cases were identified. Most patients were males (92.9%) with pT3 (26.8%) or pT4 (58.1%) N+ (53.6%) tumors. All patients received laryngectomy as the primary treatment, with 75% of patients receiving adjuvant radiation therapy or chemoradiotherapy. Complications with TEP were common (65.2%). The most frequent problem was salivary leakage (50.0%), which at the same time was the most common reason for changing the prosthesis. On univariate regression analysis, prosthesis placement time after adjuvant radiotherapy (hazard ratio [HR]: 4.17, 95% confidence interval [CI]: 2-8.69), secondary prosthesis placement after primary surgery (HR: 3.97, 95% CI: 1.99-7.9), and laryngectomy with flap reconstruction (HR: 1.96, 95% CI: 0.99-3.89) were significant prognosticators for complications. Multivariate regression analysis revealed secondary prosthesis placement after adjuvant radiotherapy (HR: 3.66, 95% CI: 1.39-9.68) or after primary surgery (HR: 2.57, 95% CI: 0.92-7.2) to be the strongest predictors of reduced TEP/VP-CFS.
Secondary prosthesis placement after primary surgery, placement after previous irradiation, and laryngectomy with flap reconstruction are predictors of poor TEP/VP-CFS. Planned adjuvant radiotherapy is not a contraindication for TEP with prosthetic placement, but it is very important to place the prosthesis during the primary surgery or at least before scheduled radiotherapy.
4 Laryngoscope, 2020.
目的/假设：评估癌症治疗后行声门重建术患者行气管食管造口并发症的人口统计学、临床特征、处理方法和预后指标。
回顾性分析。
对 1996 年至 2015 年期间在一家三级转诊中心诊断的病例进行回顾性分析。采用多变量逻辑回归确定与气管食管造口术（TEP）和人工发声器-并发症无生存（TEP/VP-CFS）相关的因素。
共确定了 114 例病例。大多数患者为男性（92.9%），肿瘤分期为 pT3（26.8%）或 pT4（58.1%）N+（53.6%）。所有患者均接受了喉切除术作为主要治疗方法，其中 75%的患者接受了辅助放疗或放化疗。TEP 并发症很常见（65.2%）。最常见的问题是唾液漏（50.0%），同时也是更换假体的最常见原因。单因素回归分析显示，辅助放疗后假体放置时间（危险比[HR]：4.17，95%置信区间[CI]：2-8.69）、初次手术后再次放置假体（HR：3.97，95% CI：1.99-7.9）和喉切除术伴皮瓣重建（HR：1.96，95% CI：0.99-3.89）是并发症的显著预后因素。多因素回归分析显示，辅助放疗后（HR：3.66，95% CI：1.39-9.68）或初次手术后（HR：2.57，95% CI：0.92-7.2）再次放置假体是 TEP/VP-CFS 降低的最强预测因子。
初次手术后再次放置假体、初次手术后再次放置假体和喉切除术伴皮瓣重建是 TEP/VP-CFS 不良的预测因子。计划行辅助放疗并不是 TEP 置管和人工发声器置入的禁忌证，但在初次手术中或至少在计划放疗前放置假体非常重要。
4 级喉镜，2020 年。
