Otolaryngology-Head and Neck Surgery, NYU Grossman School of Medicine, New York, New York, U.S.A.
Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, U.S.A.
Laryngoscope. 2024 Jan;134(1):198-206. doi: 10.1002/lary.30857. Epub 2023 Jun 27.
Management of Enlarging tracheoesophageal fistula (TEF) with Voice Prosthesis in Laryngectomized Head and Neck Cancer Patients.
An enlarging TEF following voice prosthesis placement impacts patient quality of life, risks airway compromise, and can lead to aspiration pneumonia. Pharyngoesophageal strictures have previously been reported to be associated with TEF enlargement and leakage. We describe a series of patients with enlarging TEFs after Tracheoesophageal puncture (TEP) for voice prosthesis who required pharyngoesophageal reconstruction.
Retrospective case series of laryngectomized H&N cancer patients with primary or secondary TEP who underwent surgical management for enlarging TEF site between 6/2016-11/2022.
Eight patients were included. The mean age was 62.8 years old. Seven patients had a history of hypothyroidism. Of seven with prior H&N radiation history, two had both historical and adjuvant radiation. Two of the eight TEPs were placed secondarily. Mean time from TEP to enlarging TEF diagnosis was 891.3 days. Radial forearm-free flaps were used in five patients. Six had stenosis proximal to the TEF whereas one had distal stenosis and one had no evidence of stenosis. Mean length of stay was 12.3 days. Mean follow-up was 400.4 days. Two required a second free flap for persistent fistula.
Surgical reconstruction of enlarging TEFs due to TEP/VP placement is effective in combination with addressing underlying pharyngeal/esophageal stenosis contributing to TEF enlargement and leakage. Radial forearm-free flaps have the additional benefit of a long vascular pedicle to access more distant and less-irradiated recipient vessels. Many fistulae are resolved after the first flap reconstruction, but some may require subsequent reconstruction in case of failure.
4 Laryngoscope, 134:198-206, 2024.
放置声带假体后扩大的气管食管瘘（TEF）会影响患者的生活质量，有气道阻塞的风险，并可导致吸入性肺炎。先前已有报道称咽食管狭窄与 TEF 扩大和渗漏有关。我们描述了一组因声门重建而接受气管食管穿刺（TEP）的喉癌患者，他们因扩大的 TEF 而需要进行咽食管重建。
回顾性病例系列研究，纳入了 2016 年 6 月至 2022 年 11 月间因扩大的 TEF 部位而接受手术治疗的原发性或继发性 TEP 的喉咽癌患者。
纳入了 8 例患者。平均年龄为 62.8 岁。7 例患者有甲状腺功能减退病史。7 例患者有 H&N 放疗史，其中 2 例有既往和辅助放疗史。8 例 TEP 中有 2 例是继发性的。从 TEP 到诊断为扩大的 TEF 的平均时间为 891.3 天。5 例患者使用游离桡侧前臂皮瓣。6 例患者在 TEF 近端有狭窄，1 例患者在远端有狭窄，1 例患者无狭窄证据。平均住院时间为 12.3 天。平均随访时间为 400.4 天。2 例患者因持续瘘管需要第二次游离皮瓣。
由于 TEP/VP 放置导致的扩大 TEF 的手术重建，结合处理导致 TEF 扩大和渗漏的潜在咽/食管狭窄，是有效的。游离桡侧前臂皮瓣具有额外的优势，即其血管蒂较长，可用于接近更远和受照射较少的受区血管。许多瘘管在第一次皮瓣重建后得到解决，但有些瘘管可能需要再次重建以防止失败。
4 级喉镜，134：198-206，2024。
