Department of Otolaryngology, Head and Neck, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Otolaryngology, Head and Neck, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, and State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Clin Exp Rheumatol. 2022 Sep;40(8):1554-1559. doi: 10.55563/clinexprheumatol/iec6ff. Epub 2022 Aug 2.
Pharyngeal scarring stenosis is a rare yet very severe complication in Behçet's disease (BD). Previously, such patients had to undergo tracheostomy for life, which seriously affected the patient's speech and swallowing function. We aim to present the effect of pharyngeal reconstructive surgeries using flaps for severe pharyngeal stenosis in BD.
The medical history, the surgical procedures of reconstruction and the clinical outcomes of BD cases with pharyngeal stenosis were analysed. British Medical Research Council questionnaire (MRC), Chinese version of the Swallowing Quality-of-Life Questionnaire (SWQOL), the dysphagia score (DS) and the penetration-aspiration scale (PAS) based on videofluoroscopic swallowing study were used.
Six BD cases with pharyngeal stenosis underwent reconstructive operations. Submental island flaps and forearm free flaps were used in reconstructive procedures in three female and three male patients, respectively. All patients successfully removed the tracheotomy cannula and nasal feeding tube after reconstruction. Dyspnoea was significantly relived as MRC scores decreased from 3 (3-4) to 1 (1-2) (p=0.020, Z=-2.333). SWQOL scores were remarkably improved from 782.5 (657.0-854.0) to 826.5 (768.0-864.0) (p=0.027, Z=-2.207). There was non-significant decrease in DS (from 2.5 to 1.5, p=0.066, Z=-1.841) and increase in PAS (from 1 to 1.5, p=0.317, Z=-1.000).
Reconstructive surgery using flaps is an effective and safe approach to rebuild pharyngeal cavity in BD patients with severe pharyngeal stenosis, which can improve the quality of life of these patients.
咽瘢痕性狭窄是贝赫切特病（BD）一种罕见但非常严重的并发症。此前，此类患者必须终生进行气管造口术，这严重影响了患者的言语和吞咽功能。我们旨在介绍使用皮瓣进行 BD 严重咽狭窄重建的效果。
分析了咽狭窄 BD 病例的病史、重建手术过程和临床结果。采用英国医学研究委员会问卷（MRC）、中文版吞咽生活质量问卷（SWQOL）、基于视频透视吞咽研究的吞咽障碍评分（DS）和渗透-吸入评分（PAS）。
6 例 BD 伴咽狭窄患者行重建手术。3 例女性和 3 例男性患者分别采用颏下岛状皮瓣和游离前臂皮瓣进行重建。所有患者重建后均成功拔除气管切开套管和鼻饲管。MRC 评分从 3（3-4）降至 1（1-2），呼吸困难明显缓解（p=0.020，Z=-2.333）。SWQOL 评分从 782.5（657.0-854.0）显著提高至 826.5（768.0-864.0）（p=0.027，Z=-2.207）。DS 无显著下降（从 2.5 降至 1.5，p=0.066，Z=-1.841），PAS 略有增加（从 1 升至 1.5，p=0.317，Z=-1.000）。
使用皮瓣进行重建手术是一种有效且安全的方法，可重建 BD 严重咽狭窄患者的咽腔，提高这些患者的生活质量。
