Department of Otorhinolaryngology, Head and Neck Surgery, Katholisches Marienkrankenhaus gGmbH, Alfredstrasse 9, 22087, Hamburg, Germany.
Department of General, Visceral, Thoracic and Vascular Surgery, Katholisches Marienkrankenhaus gGmbH, Hamburg, Germany.
Eur Arch Otorhinolaryngol. 2021 Nov;278(11):4525-4534. doi: 10.1007/s00405-021-06709-5. Epub 2021 Mar 14.
Iatrogenic cervical esophageal perforations (CEP) and postoperative salivary fistulas (PSF) are some of the complications requiring treatment in head and neck surgery. Conservative, surgical and endoscopic therapeutic techniques are used. Both CEP and PSF are potentially life-threatening complications and require intensive treatment. Endoscopic negative pressure therapy (ENPT) is an innovative endoscopic surgical procedure for the treatment of transmural intestinal defects throughout the gastrointestinal tract (GIT). In this retrospective study, we demonstrate its application in head and neck surgery.
In ENPT, open-pore drains are placed endoscopically in the wound area. The drains can be inserted in an intraluminal position spanning the length of the defect (intraluminal ENPT), or through the defect into the extraluminal wound cavity (intracavitary ENPT). An electronic suction pump applies and maintains a continuous negative pressure of - 125 mmHg over a period of several days. The endoscopic drains are changed at regular intervals every few days until stable intracorporeal wound healing by secondary intention or defect closure is achieved. Between 06/2008 and 05/2019 ten patients (f = 3, m = 7; 46-78 years old) were treated with ENPT for CEP or PSF. Five patients had postoperative wound defects with consecutive PSF after total laryngectomy or floor of mouth resection. In five patients iatrogenic CEP was found following endoscopic procedures.
In all patients treated with ENPT, healing of the perforation defect or fistula was achieved (cure rate 100%). The median treatment duration was 13.7 days (range 4-42 days). No relevant treatment-associated complications were observed.
ENPT is a new, minimally invasive method for treating PSF and CEP.
医源性颈段食管穿孔（CEP）和术后唾液瘘（PSF）是头颈部外科需要治疗的并发症之一。保守、手术和内镜治疗技术都有应用。CEP 和 PSF 都是潜在的危及生命的并发症，需要强化治疗。内镜负压治疗（ENPT）是一种创新的内镜手术，可用于治疗整个胃肠道（GIT）的壁内肠缺损。在这项回顾性研究中，我们展示了它在头颈部外科的应用。
在 ENPT 中，通过内镜将多孔引流管放置在伤口区域。引流管可以插入腔内以跨越缺损长度（腔内 ENPT），或通过缺损进入腔外伤口腔（腔内置管 ENPT）。电子抽吸泵在数天内施加并维持持续的 -125mmHg 负压。每隔几天定期更换内镜引流管，直到通过二期愈合或缺损闭合实现稳定的体腔伤口愈合。2008 年 6 月至 2019 年 5 月，10 名患者（女性 3 例，男性 7 例；年龄 46-78 岁）因 CEP 或 PSF 接受 ENPT 治疗。5 例患者在全喉切除术或口底切除术后并发连续 PSF 的术后伤口缺损。5 例患者因内镜操作后发现医源性 CEP。
所有接受 ENPT 治疗的患者均治愈穿孔或瘘（治愈率 100%）。中位治疗时间为 13.7 天（范围 4-42 天）。未观察到与治疗相关的并发症。
ENPT 是治疗 PSF 和 CEP 的一种新的微创方法。
