全喉切除术后Provox Vega发音纽Ⅱ期植入适应证及常见并发症防治的研究

Indications and complications prevention and management of phaseⅡimplantation of Provox Vega voice prosthesis after total laryngectomy

目的探讨Provox Vega发音纽用于喉切除术后Ⅱ期植入的手术适应证及常见术后并发症防治策略。方法前瞻性研究2021年5月至2022年1月在复旦大学附属眼耳鼻喉科医院耳鼻咽喉头颈外科行Provox Vega发音纽Ⅱ期植入的20例全喉切除术后患者的临床资料, 其中男性19例, 女性1例, 年龄37~76(60.0±8.4)岁, 总结手术适应证及常见术后并发症的预防和处理。采用描述性方法进行分析。结果全喉切除术后造口无明显狭窄、食道入口无明显狭窄、无明显瘢痕体质、无明显张口受限、放射治疗后颈部无明显僵硬及后仰受限以及手术或放射治疗后半年以上为Provox Vega发音纽Ⅱ期植入基本手术适应证。20例患者中18例植入成功, 1例术中植入失败, 1例术后1周因出血取出。常见术后并发症包括气管食管穿刺瘘口感染(2例), 穿刺瘘口出血(1例), 颈深部(椎前)脓肿(1例), 气管食管穿刺内瘘口肉芽增生(1例), 发音纽内陷嵌顿(2例)及发音纽周围渗漏(2例), 经处理后均痊愈。结论 Provox Vega发音纽临床Ⅱ期植入的总体安全性好, 但是需要掌握一定的植入适应证, 术后常见并发症可以通过预防性和补救性的处理措施得到解决。

Objective To explore the indications and management of common postoperative complications of phase II tracheoesophageal puncture(TEP)for Provox Vega voice prosthesis after total laryngectomy.Methods The clinical data of 20 patients undergoing phase II TEP for Provox Vega voice prosthesis in our hospital between May 2021 and January 2022 were analyzed.Among them,there were 19 males and 1 female,aged from 37 to 76 years,with an average age of(60.0±8.4)years.The surgical indications and the prevention and treatment of common postoperative complications were summarized.Descriptive analysis was used in this research.Results The basic surgical indications were as following:after total laryngectomy,there was no stenosis of the stoma and esophagus entrance,no scar constitution,no mouth opening restriction,no stiffness and backward restraint of the neck after radiotherapy,and more than half a year apart surgery or radiotherapy.Among the 20 patients,18 underwent implantation successfuly,1 failed in the operation,and for 1 patient,the prosthesis was removed due to bleeding 1 week after implantation.The common postoperative complications included TEP fistula infection(2 cases),the TEP fistula bleeding(1 case),deep neck(prevertebral)abscess(1 case),granulation at the inner side of the TEP fistula(1 case),invagination of the prosthesis(2 cases)and leakage around the prosthesis(2 cases).All patients were cured with different interventions.Conclusions The Provox Vega voice prosthesis is generally safe for phaseⅡimplantatione,but implantation indications need to be established.Common postoperative complications can be solved through preventive and remedial interventions.