De Virgilio Armando, Costantino Andrea, Festa Bianca Maria, Russo Elena, Malvezzi Luca, Pellini Raul, Colombo Giovanni, Spriano Giuseppe, Mercante Giuseppe, Ferreli Fabio
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.
Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
Eur Arch Otorhinolaryngol. 2022 Dec;279(12):5839-5849. doi: 10.1007/s00405-022-07490-9. Epub 2022 Jun 22.
To compare the efficacy of different reconstructive techniques in preventing pharyngocutaneous fistula (PCF) after salvage total laryngectomy (STL).
An arm-based network analysis was conducted using a Bayesian hierarchical model according to the PRISMA-NMA guidelines.
A total of 1694 patients with a median age of 64 years (n = 1569, 95% CI: 62-66 years) were included. If compared to primary pharyngeal closure alone, only a pedicled flap onlay (PFO) showed a statistically significant reduction in PCF rate (OR: 0.35, CI: 0.20-0.61). PFO seemed to perform better than other treatments according to the rank probabilities test (39.9% chance of ranking first).
A pedicled flap placed with an overlay technique might be preferred over a patch reconstruction to prevent PCF after STL.
比较不同重建技术在挽救性全喉切除术后预防咽皮肤瘘（PCF）方面的疗效。
根据PRISMA-NMA指南，使用贝叶斯分层模型进行基于臂的网络分析。
共纳入1694例患者，中位年龄64岁（n = 1569，95%CI：62 - 66岁）。与单纯一期咽闭合相比，仅带蒂皮瓣覆盖（PFO）显示PCF发生率有统计学显著降低（OR：0.35，CI：0.20 - 0.61）。根据排序概率检验，PFO似乎比其他治疗效果更好（排名第一的概率为39.9%）。
在挽救性全喉切除术后预防PCF方面，采用覆盖技术放置带蒂皮瓣可能比补片重建更可取。
