透過您的圖書館登入
IP:3.86.235.207
  • 期刊

Strategy of Surgical Intervention for Post-laryngectomy Pharyngocutaneous Fistula

全喉切除術後併發咽皮廔管的外科治療方法

摘要


背景:全喉切除常用於喉部及下咽部惡性腫瘤病人。咽皮廔管為腫瘤切除術後常見的併發症。其治療準則目前仍無定案。因此此類病人的重建多依據醫師的臨床判斷。目的及目標:此篇研究目的為探討本院的相關病例,並提出可能的治療依據,以供此類病患的重建參考。材料及方法:本研究從2011年至2013年間,共收入12位病患。病患均經診斷為喉部及下咽部惡性腫瘤並接受全喉切除術後之病人。其咽部缺損接受直接縫合或游離皮瓣重建。共有12位日後併發咽皮廔管並接受手術治療。其中有7位曾接受術前放射治療。廔管切除術後,以直接縫合或胸大肌皮瓣重建缺損。追蹤期為6~18個月。結果:此研究共包含10位男性及2位女性。我們根據廔管手術治療方式分成兩組。其中一組8位病人以直接縫合方式重建廔管缺損,當中有2位廔管復發,其中1位經再次直接縫合後癒合良好,另外1位則接受胸大肌皮瓣手術後癒合;另一組4位病人以胸大肌皮瓣重建廔管缺損,其中1位廔管復發合併膿瘍感染,後因頸動脈破裂死亡。除外,我們還同時探討放射治療對廔管復發的影響,術前接受放射治療中有2位病人的廔管復發,且其中1位病人因頸動脈破裂死亡。未接受術前放射治療的病人,則有1位廔管復發,經直接縫合廔管後癒合良好。結論:早期外科手術治療對於咽皮廔管是有效的方法。其中,手術直接縫合為一簡單方法且預後在尚可接受之範圍。如遇到廔管周邊軟組織不足及不健康、大或高滲漏量廔管,胸大肌皮瓣可作為替代性方法。胸大肌皮瓣也可用於直接縫合術後卻復發的病人。

關鍵字

無資料

並列摘要


Background: Total laryngectomy is a common surgical option in advanced laryngeal / hypopharyngeal cancer. Pharyngocutaneous fistula is a common complication after the tumor ablation surgery. The strategies of treatment are still controversial and lack of consensus. Thus, the options of surgical management depend on the surgeon’s clinical judgement and experiences. Aim and Objectives: The aim of this study is to review our experiences in the, surgical treatment of pharyngocutaneous fistula and provide an algorithm of the reconstruction options for the treatment of these patients. Materials and Methods: There were 12 patients included in this study from 2011 to 2013 in our institute. These patients all were diagnosed as hypopharyngeal or laryngeal cancers and underwent total laryngectomy. The pharyngeal defect was closed by primary closure or free anterolateral thigh flap reconstruction. They developed the pharyngocutaneous fistulas. Seven of them received pre-operative radiotherapy. All patients received surgical interventions for the pharyngocutaneous fistula within one month. After the fistulectomy, the defect was reconstructed by direct closure or pectoralis major flap. The follow-up period was six months to eighteen months. Results: There were 10 males and 2 females in this study. We divided these patients into two groups according to the methods of surgical intervention for the pharyngocutaneous fistula. Eight patients received direct closure, and two of them developed recurrent fistula. One recurrent fistula healed after second direct closure, the other recurrent fistula underwent second and third direct closure but failed and PM flap was used to close the fistula successfully. In the group of four patients who had PM flap reconstruction in the initial surgical management, one patient developed recurrent fistula with abscess formation, and then expired due to carotid rupture. Besides, we also compared the radiation effect to the pharyngocutaneous fistula recurrence. In the pre-operative radiotherapy group, two patients had recurrent fistulization and one of them had mortality due to carotid rupture. The five patients without pre-operative radiotherapy had only one recurrent fistulization and healed. Conclusion: Early surgical treatment within one month after the development of fistula is recommended. Direct closure for pharyngocutaneous fistula in patients who had previously undergone flap reconstruction for pharyngeal closure is a simple method with acceptable results. PM flap is to be used in patients who had primary pharyngeal closure without flap, high output fistula or large defect. Furthermore, the PM flap could be used as a salvage procedure in the patients who failed in direct closure.

延伸閱讀