T-tube Diversion and Vacuum Assisted Closure System in the Management of Pharyngocutaneous Fistula-A Case Report

以T形管分流加上VAC裝置治療咽喉廔管之成功案例報告

周鼎茂(Ting-Mao Chou) ； 蕭振仁(Jenn-Ren Hsiao) ； 薛元毓(Yuan-Yu Hsueh)

《臺灣整形外科醫學會雜誌》 21卷3期 (2012/09) Pp. 222-229

https://doi.org/10.7096/TJTSPS.201209.0222

摘要

背景：咽喉廔管是在歷經咽喉切除以及重建術後病人身上常見的併發症。在受過放射治療的病人中，此併發症尤其常見。咽喉廔管治療上的原則包括中斷由口進食輔以鼻胃管引流，適當引流及減少滲液，同時以適當的換藥方式甚或手術來縮小廔管面積。目標及目的：分享以T-tube來引流滲液並輔以VAC裝置促進廔管癒合，成功治療一名咽喉廔管患者的經驗。材料及方法：我們報告一位50歲男性，在經過咽喉全切除術及放射治療後，發生了咽喉廔管的併發症。在經過三角胸皮瓣以及胸大肌皮瓣的重建後，廔管依然無法治癒。因此我們改以T-tube引流廔管滲液，同時輔以VAC裝置來促進廔管癒合。最後病人得以康復並順利出院。結果：病人之咽喉廔管在經過上述治療後完全癒合，傷口也未再出現蓄膿等感染徵狀。術後所追蹤的食道攝影證實已無廔管滲漏情形。結論：在廔管滲液未完全獲得控制，且周圍傷口狀況不佳的時機下，行皮瓣手術填塞廔管，仍難脫失敗的命運。相反的，如能適當的將滲液以引流管由其他出口導流，並以VAC裝置促進廔管癒合，加上適當的感染控制直營養調控，則有可能不需手術也得到令人滿意的結果。

並列摘要

Background: Pharyngocutaneous fistula is a common complication in patients who have undergone total laryngectomy, especially in whom receiving irradiation, either adjuvant or neo-adjuvant. The keystone of managements includes control of the effluent, cessation of oral intake, placement of a nasogastric tube, and minimizing of the fistula size. Aim and Objectives: To share the experience of dealing with pharyngocutaneous fistula utilizing T-tube diversion and VAC therapy. Materials and Methods: We present a case of a pharyngocutaneous fistula after total laryngectomy, who was successfully treated with a method combining T-tube diversion of the effluent and vacuum assisted closure system. Results: The effluent was efficiently diverted by the T-tube to a healthier exit, and the wound healed smoothly with the aid of VAC system. Esophagogram showed no evidence of pharyngeal leakage after the treatment has been completed. Conclusion: In patients with pharyngocutaneous fistula, diversion of the effluent with T-tube and wound bed care with VAC system can provide an effective way to stabilize, or even diminish the fistula. (J Taiwan Soc of Plast Surg 2012;21:222~229)

並列關鍵字

vacuum assisted closure ； VAC ； diversion ； pharyngocutaneous fistula