Department of Otolaryngology Head and Neck Surgery, Loyola University Medical Center, 2160 S. First Ave, Maywood, Illinois.
Department of Surgery, Loyola University Medical Center, 2160 S. First Ave, Maywood, Illinois; Burn and Shock Trauma Research Institute, Loyola University Chicago, 2160 S. First Ave, Maywood, Illinois.
J Voice. 2023 Jul;37(4):633.e1-633.e6. doi: 10.1016/j.jvoice.2021.03.025. Epub 2021 May 21.
In a postlaryngectomy patient, tracheoesophageal (TE) speech is considered to be the most effective and preferred method of communication. Previous research has demonstrated that despite an appropriately sized TE prosthesis placement at the time of puncture, there are a portion of patients that require resizing postoperatively. The purpose of this study was to report on the variability of the tracheoesophageal prosthesis length.
Retrospective chart review.
Tertiary care academic medical center.
This was a retrospective chart review of 62 patients who underwent secondary tracheoesophageal puncture (TEP) at a tertiary care academic medical center from January 2008 to November 2019. Patient demographic information, average changes in prosthesis length, number of prosthesis adjustments, and timing of prosthesis exchanges were collected.
62 patients met criteria for study inclusion. Mean age was 61.96 years old with 49 being male (79%) and 13 (21%) females. Overall change in prosthesis length was - 3.85 mm ± 3.58 with time to first prosthesis change at 2.29 months ± 2.73. There was an average of 4.37 changes ± 3.43 before reaching a stable length. Twenty-six patients (41.9%) had increases in their prosthesis length resulting in closure of the tracheoesophageal fistula requiring seven patients (11.3%) to return to the operating room for repuncturing. History of smoking (P = 0.02), Blom-Singer prosthesis type (P = 0.03), and larger diameter (P = 0.01) appeared to be predisposing factors for a fluctuating prosthesis length.
Tracheoesophageal prosthesis length decreases over time for secondary punctures, requiring adjustments with a speech language pathologist. There are a clinically significant portion that have fluctuations in prosthesis length resulting in an increased risk for requiring re-puncturing.
在喉切除术后患者中，气管食管（TE）语音被认为是最有效和首选的交流方式。先前的研究表明，尽管在穿刺时放置了大小合适的 TE 假体，但仍有一部分患者需要在术后进行调整。本研究的目的是报告气管食管假体长度的变化情况。
回顾性图表审查。
三级保健学术医疗中心。
这是对 2008 年 1 月至 2019 年 11 月在三级保健学术医疗中心接受二次气管食管穿刺（TEP）的 62 例患者的回顾性图表审查。收集了患者的人口统计学信息、假体长度的平均变化、假体调整次数以及假体更换时间。
62 例患者符合研究纳入标准。平均年龄为 61.96 岁，其中男性 49 例（79%），女性 13 例（21%）。假体长度的总体变化为-3.85 毫米±3.58，首次更换假体的时间为 2.29 个月±2.73。平均需要 4.37 次调整±3.43 才能达到稳定的长度。26 例患者（41.9%）的假体长度增加，导致气管食管瘘闭合，需要 7 例患者（11.3%）返回手术室重新穿刺。吸烟史（P=0.02）、Blom-Singer 假体类型（P=0.03）和更大直径（P=0.01）似乎是假体长度波动的易患因素。
对于二次穿刺，气管食管假体长度随时间逐渐缩短，需要与言语语言病理学家一起进行调整。有相当一部分患者的假体长度波动较大，导致再次穿刺的风险增加。
