改良负压封闭引流装置在难治性咽瘘治疗中的应用

Application of the improved vacuum sealing drainage device in the treatment of refractory pharyngocutaneous fistula

目的探讨改良负压封闭引流(VSD)装置在难治性咽瘘治疗中的应用。方法两例患者诊断分别为下咽癌(环后区,T2N2M0)和喉癌(声门区,T1N0M0),年龄为48岁和62岁,行下咽肿瘤切除术和支撑喉镜下二氧化碳激光声带部分切除术,术后下咽癌患者行放化疗,喉癌患者行放疗,分别于同步放化疗后5 d、放疗后146 d出现难治性咽瘘,应用自制改良VSD装置治疗,对两例患者咽瘘愈合过程进行观察。结果2例患者使用改良VSD装置治疗后分别于第6天、第3天瘘口红肿消退,第58天、第38天创面明显缩小,后行咽瘘修补术,第74天、第63天咽瘘愈合。结论经过改良的VSD装置可以根据创面情况灵活应用,有助于头颈部肿瘤治疗后并发的难治性咽瘘的治疗。

Objective To explore the therapeutic effect of the improved vacuum sealing drainage(VSD)device on refractory pharyngocutaneous fistula.Method Two patients with refractory pharyngocutaneous fistula were reported in this article.A 48-year-old patient with hypopharyngeal carcinoma(postcricoid region,clinical T2 N2 M0)experienced refractory pharyngocutaneous fistula on the fifth day of concurrent radiotherapy and chemotherapy after tumor resection.A similar fistula occurred in another patient aged 62 with laryngeal carcinoma experiencing partial vocal fold resection by CO2 laser 146 days after radiation therapy.The improved VSD devices was applied to assist fistula treatment in both patients,and the healing process was observed.Results After the application of the improved VSD device,the swelling of the fistula subsided on the sixth and third day in patients 1 and 2,and it was repaired when the wound area contracted obviously on days 58 and 38,respectively.Then,the pharyngocutaneous fistula healed on days 74 and 63,respectively.Conclusion The improved VSD device can be used flexibly according to the wound condition,and is helpful for treating refractory pharyngocutaneous fistula complicated with head and neck carcinoma.