Shires Courtney B, Schertzer Joseph S, Ottenstein Lauren, Harris Tricia, Sebelik Merry E
West Cancer Center, Germantown, TN 38138, USA.
Department of Otolaryngology, School of Medicine, Emory University, Atlanta, GA 30322, USA.
J Pers Med. 2024 Sep 24;14(10):1021. doi: 10.3390/jpm14101021.
Total laryngectomy is used to cure advanced larynx cancer in many patients. The removal of the larynx requires the rehabilitation of the patient's ability to communicate, and one common method is to place a tracheoesophageal voice prosthesis (TEP) as a secondary procedure after the patient has completed cancer treatment. The traditional technique utilizes a rigid esophagoscope for access, but this can prove difficult in many patients who have kyphosis, scarring of the neck, or trismus. We describe a technique to allow TEP placement in these challenging patients that does not utilize rigid esophagoscopy to access the tracheoesophageal puncture site. For more than 15 years, the senior authors of this study have used this technique in patients in whom traditional methods of TEP with rigid esophagoscope were unsuccessful or not attempted due to the anticipated high probability of failure. The ease of this technique has prompted its use for all patients undergoing secondary TEP placement in their practice. The technique is described in detail in the Methods section below. The described method has been successfully utilized to place TEPs in many patients with challenging anatomy. There have been no failed placements, including a patient with severe trismus who was able to have a TEP placed by placing the chest tube and flexible endoscope transnasally. Further, because of precise visualization and ease of the technique, there have been no observed complications of injury to the pharyngoesophageal lumen or creation of a false passage. The use of a chest tube and flexible scope allows for the protection of the pharyngoesophageal lumen, precise visualization and placement of the puncture, and avoidance of a false tracheoesophageal passage, all while minimizing the need for extension of the patient's neck. This has proven ideal for patients suffering the consequences of cancer treatment such as cervical scarring, fibrosis, kyphosis, and trismus.
全喉切除术用于治疗许多晚期喉癌患者。切除喉部后需要恢复患者的沟通能力，一种常见的方法是在患者完成癌症治疗后作为二期手术放置气管食管语音假体（TEP）。传统技术使用硬式食管镜进行操作，但在许多患有脊柱后凸、颈部瘢痕或牙关紧闭的患者中，这可能会很困难。我们描述了一种在这些具有挑战性的患者中放置TEP的技术，该技术不使用硬式食管镜来进入气管食管穿刺部位。在超过15年的时间里，本研究的资深作者已将该技术用于那些因预期失败概率高而导致使用硬式食管镜进行TEP传统方法不成功或未尝试的患者。该技术的简便性促使其在他们的实践中用于所有接受二期TEP放置的患者。该技术在下面的方法部分有详细描述。所描述的方法已成功用于为许多解剖结构具有挑战性的患者放置TEP。没有放置失败的情况，包括一名患有严重牙关紧闭的患者，通过经鼻放置胸管和柔性内窥镜成功放置了TEP。此外，由于该技术可视化精确且操作简便，未观察到咽食管腔损伤或形成假通道的并发症。使用胸管和柔性内窥镜可保护咽食管腔，精确可视化和放置穿刺点，并避免形成假的气管食管通道，同时最大限度地减少患者颈部伸展的需要。这已被证明对患有癌症治疗后果（如颈部瘢痕、纤维化、脊柱后凸和牙关紧闭）的患者非常理想。
