Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Acta Otolaryngol. 2023 May;143(5):434-439. doi: 10.1080/00016489.2023.2203700. Epub 2023 Apr 27.
Pharyngocutaneous fistula (PCF), a major complication of total laryngectomy, is caused by pharyngeal repair failure.
Assess the usefulness of endoscopic observation of the pharyngeal suture's healing process for the early detection of PCF development.
Pharyngeal mucosal sutures were endoscopically observed postoperatively in patients who underwent total laryngectomy with primary closure.
Postoperatively, a white coat adhered to the pharyngeal mucosal suture of all patients. In most cases, the white coat gradually receded, which was considered to be a normal healing process. Thickening of the white coat and/or dehiscence of surgical wound were interpreted as 'poor healing conditions'. Three cases were judged to have developed poor healing conditions of the pharyngeal mucosal suture and one patient developed PCF. The other two patients did not develop PCF, possibly due to early detection of 'poor healing condition' and conservative approach, such as discontinuation of oral intake.
Postoperative poor healing conditions of the pharyngeal mucosal suture may be precursors to PCF development. Endoscopic observation enables early detection of these conditions and may enable the prevention of PCF.
咽瘘（PCF）是全喉切除术后的主要并发症，是由于咽修复失败引起的。
评估内镜观察咽缝合愈合过程对早期发现 PCF 发展的有用性。
对行全喉切除术并一期缝合的患者进行术后咽黏膜缝合的内镜观察。
术后所有患者的咽黏膜缝合处均附有白色外套。在大多数情况下，白色外套逐渐消退，这被认为是正常的愈合过程。白色外套的增厚和/或手术伤口的裂开被解释为“愈合不良”。有 3 例被判断为咽黏膜缝合愈合不良，1 例发生 PCF。另外两例患者未发生 PCF，可能是由于早期发现“愈合不良”并采取保守治疗，如停止口服摄入。
术后咽黏膜缝合愈合不良可能是 PCF 发展的前兆。内镜观察可早期发现这些情况，并可能预防 PCF 的发生。
