全喉术中密闭性检测预防术后咽瘘临床意义探讨

Air leakage test in total laryngectomy to prevent pharyngocutaneous fistula:A simple determination method for basic unit

目的术者缝合技术和患者愈合因素均能导致咽瘘,亟待术中客观评价喉咽残腔缝合情况的方法。本研究探讨充气密闭试验预防缝合疏朗进而降低术后咽瘘发生率的情况。方法 2015-01-08-2016-01-08中山大学肿瘤防治中心头颈科11例患者行全喉切除并常规关闭喉咽残腔,术中插胃肠营养管至喉咽吻合口下方,以40cm H2O压力触动呼吸球囊安全阀开放为上限,对喉咽残腔行加压充气密闭试验,并分析其术后咽瘘发生情况。结果 11例全喉,8例机械吻合,3例手工吻合。11例充气试验,1例为阳性(泄漏),遂术中补缝加固后再次检测阴性(未泄漏),该患者愈合良好未出现咽瘘;余10例充气试验阴性,但其中2例发生了咽瘘,且术前接受了全量放疗。随访至2016-01-08,中位随访时间7.9个月(4~12个月),11例均无瘤生存至今。结论充气检测试验可评价喉咽残腔的密闭性并指引临床补缝,有可能预防因缝合技术进而导致的咽瘘。

OBJECTIVE Surgeon suture technique and patients healing factors can lead to pharyngeal fistula,which need to be objectively evaluated with the suture method of laryngeal pharynx residual cavity.The purpose of this article was to describe a new technique of air leakage test leaving a watertight neo pharynx cavity.METHODS Eleven patients requiring a total laryngectomy for cancer were enrolled between January 8,2015 and January 8,2016.Gastrointestinal nutrition tube was inserted inferior of laryngopharyngeal anastomosis intraoperatively,setting 40 cm H2 O touches respiratory balloon pressure relief valve as the highest limitation,to test the level of inflatable airtight with the hypopharynx residual cavity pressure,and to analyze the rate of postoperative pharyngeal fistula.RESULTS Eight patients were treated with mechanical suture,whereas three patients with manual suture.Air test procedure to detect leakage was added in all patients.In our series,one case was discovered air leaked from neo pharynx cavity,which had healed well without pharyngocutaneous fistula by suturing again.Two cases undergoing high doses preoperative irradiation had pharyngocutaneous fistula in the negative air leakage test group.The final follow-up assessment was January2016,and the overall mean follow-up period was 7.9 months,ranging from 4 to 12 months,and all 11 cases survived without tumor till now.CONCLUSION The air leakage test can evaluate laryngeal pharynx residual cavity closure and guide clinical suture,and could prevent pharyngeal fistula caused by suture loose.