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首页> 外文期刊>The Laryngoscope: A Medical Journal for Clinical and Research Contributions in Otolaryngology, Head and Neck Medicine and Surgery, Facial Plastic and Reconstructive Surgery .. >Morbidity after flap reconstruction of hypopharyngeal defects.
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Morbidity after flap reconstruction of hypopharyngeal defects.

机译：皮瓣下咽缺损重建后的发病率。

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OBJECTIVES: Laryngopharyngeal reconstruction continues to challenge in terms of operative morbidity and optimal functional results. The primary aim of this study is to determine whether complications can be predicted on the basis of reconstruction in patients undergoing pharyngectomy for tumors involving the hypopharynx. In addition, we detail a reconstructive algorithm for management of partial and total laryngopharyngectomy defects. METHOD: A retrospective review was performed of 153 patients undergoing flap reconstruction for 85 partial and 68 circumferential pharyngectomies at a single institution over a 10-year period. There were 118 males and 35 females, the median age was 62 years, and mean follow up was 3.1 years. Pharyngectomy was performed for recurrence after radiotherapy in 80 patients and as primary surgery in 73. Free flap reconstruction was used in 42%, with 30 jejunal, 15 radial forearm, 11 anterolateral thigh, five rectus abdominis, and three gastro-omental flaps. Gastric transpositionand pectoralis major pedicle flap was used in 14% and 44% of patients, respectively. Morbidity was analyzed according to extent of defect, regional versus free flap, enteric versus fasciocutaneous free flap reconstruction, and the effect of laparotomy. RESULTS: The total operative morbidity and mortality rate was 71% and 3%, respectively. The most common complications were hypocalcemia in 45%, pharyngocutaneous fistula in 33%, and wound complications in 25%. The late complication and stricture rate was 26% and 15%, respectively. On univariate analysis, circumferential defects were associated with increased total (P=.046) and flap-related morbidity (P=.037), hypocalcemia (P<.001), late complications (P=.003), and stricture (P=.009). Gastric transposition had increased total (P=.007), flap-related (P=.035), late complications (P=.034), and hypocalcemia (P=.001). Pharyngocutaneous fistula was increased in patients undergoing salvage pharyngectomy for radiation failure (P=.048) compared with primary surgery. On multivariate analysis, gastric transposition independently predicted for wound complications (P=.014) and fistula (P=.012). Circumferential defects predicted for flap-related morbidity (P=.030), hypocalcemia (P=.017), and late complications (P=.042). Tracheoesophageal speech was the method of voice restoration in 44% of patients. Oral diet was achieved in 93% of patients; however, 16% required gastrostomy tube feeds for either total or supplemental nutrition. CONCLUSION: The operative morbidity associated with pharyngeal reconstruction is substantial in terms of early and late complications. We were able to predict morbidity by defect extent and reconstruction type and initial treatment modality. Swallowing function is acceptable; however, less than half of the patients undergoing pharyngectomy had tracheoesophageal puncture voice restoration.
机译：目的：喉咽重建术在手术发病率和最佳功能效果方面继续面临挑战。这项研究的主要目的是确定是否可以根据咽下肿瘤切除咽部患者的重建情况来预测并发症。另外，我们详细介绍了用于部分和全部喉咽切除术缺损管理的重建算法。方法：回顾性回顾了10年间在一家机构中对153例行皮瓣重建术的患者进行的皮瓣重建术，其中包括85例局部和68例环咽切除术。男118例，女35例，中位年龄62岁，平均随访3.1年。放射治疗后有80例患者进行了咽切除术的复发，其中73例为一次手术。42％的患者采用了游离皮瓣重建术，其中有30个空肠，15个radial骨前臂，11个前外侧大腿，5个腹直肌和3个胃网膜皮瓣。胃移位术和胸大肌蒂皮瓣分别用于14％和44％的患者。根据缺损的程度，区域性皮瓣与游离皮瓣的重建，肠内皮筋膜与游离皮筋膜的游离皮瓣重建以及剖腹手术的效果分析发病率。结果：总手术发病率和死亡率分别为71％和3％。最常见的并发症是低血钙症占45％，咽皮肤瘘占33％，伤口并发症占25％。晚期并发症和狭窄率分别为26％和15％。单因素分析显示，周围缺损与总皮损增加（P = .046）和皮瓣相关发病率（P = .037），低钙血症（P <.001），晚期并发症（P = .003）和狭窄（P = .009）。胃换位术的总数增加（P = .007），皮瓣相关性（P = .035），晚期并发症（P = .034）和低钙血症（P = .001）。与原发手术相比，因放射衰竭而进行抢救性咽切除术的患者的咽皮肤瘘管增加（P = .048）。在多变量分析中，胃换位可独立预测伤口并发症（P = .014）和瘘管（P = .012）。预测皮瓣相关发病率（P = .030），低血钙症（P = .017）和晚期并发症（P = .042）的周向缺陷。气管食管语音是44％患者的声音恢复方法。 93％的患者实现了口服饮食;但是，有16％的人需要用胃造口管饲喂全部或补充营养。结论：就早期并发症和晚期并发症而言，与咽部重建相关的手术发病率很高。我们能够通过缺陷程度，重建类型和初始治疗方式来预测发病率。可以吞咽功能;然而，接受咽切除术的患者中只有不到一半的患者进行了气管食管穿刺语音恢复。

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