Locatello Luca Giovanni, Licci Giuseppe, Maggiore Giandomenico, Gallo Oreste
Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3, 50134 Florence, Italy.
Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy.
J Clin Med. 2021 Dec 24;11(1):100. doi: 10.3390/jcm11010100.
Pharyngocutaneous fistula (PCF) is a frequent complication after total laryngectomy, with an incidence of up to 65%. Many conservative or invasive approaches are available and the choice among them is usually made on a case-by-case basis. The aim of the present review is to critically summarize the available evidence of the effectiveness of the non-surgical management of PCF.
A systematic review and a meta-analysis of the literature were conducted, according to the PRISMA guidelines. Studies investigating botulinum toxin therapy, scopolamine transdermal patch, hyperbaric oxygen therapy (HBOT), and negative pressure wound therapy (NPWT) were assessed. Complete fistula closure after the initiation of non-surgical treatment was the main outcome.
After the application of selection criteria, a total of seven articles and 27 patients were included in the present review. All the eligible studies were descriptive case series, while only one article used a standard group as a comparison. The mean age was 63.3 and 14 patients (51.9%) had previously received RT. The reported comorbidities were diabetes, ischemic heart disease, hypertension, dyslipidemia, COPD, and atrial fibrillation. With a mean healing time of 25.0 days, the overall success rate was 92.6%.
Non-surgical treatment of PCF is only based on the experience of small series. Although success rates seem promising, the absence of properly designed comparative studies does not allow us, at present, to identify ideal candidates for these non-invasive management strategies for PCF.
咽皮肤瘘（PCF）是全喉切除术后常见的并发症，发生率高达65%。有多种保守或侵入性治疗方法可供选择，通常需根据具体病例逐一做出选择。本综述的目的是批判性地总结PCF非手术治疗有效性的现有证据。
根据PRISMA指南对文献进行系统综述和荟萃分析。评估了研究肉毒杆菌毒素疗法、东莨菪碱透皮贴剂、高压氧疗法（HBOT）和负压伤口疗法（NPWT）的研究。非手术治疗开始后瘘管完全闭合是主要结局。
应用选择标准后，本综述共纳入7篇文章和27例患者。所有符合条件的研究均为描述性病例系列，仅有1篇文章使用标准组作为对照。平均年龄为63.3岁，14例患者（51.9%）既往接受过放疗。报告的合并症有糖尿病、缺血性心脏病、高血压、血脂异常、慢性阻塞性肺疾病和心房颤动。平均愈合时间为25.0天，总体成功率为92.6%。
PCF的非手术治疗仅基于小样本系列的经验。尽管成功率似乎很有前景，但目前缺乏设计合理的对照研究，使我们无法确定这些PCF非侵入性管理策略的理想适用人群。
