Functional outcomes after circumferential pharyngoesophageal reconstruction

被引:66
作者
Lewin, JS [1 ]
Barringer, DA [1 ]
May, AH [1 ]
Gillenwater, AM [1 ]
Arnold, KA [1 ]
Roberts, DB [1 ]
Yu, P [1 ]
机构
[1] Univ Texas, MD Anderson Canc Ctr, Sect Speech Pathol & Audiol, Dept Head & Neck Surg, Houston, TX 77030 USA
关键词
D O I
10.1097/01.MLG.0000165456.01648.B8
中图分类号
R-3 [医学研究方法]; R3 [基础医学];
学科分类号
1001 ;
摘要
Objective. To determine functional speech and swallowing outcomes, morbidity, and complication rates after reconstruction of circumferential pharyngoesophageal defects using a jejunal versus an anterolateral thigh (ALT) flap. Study Design: Retrospective analysis. Methods. We reviewed the medical records of 58 patients with circumferential pharyngoesophageal defects, 27 with ALT flap reconstruction, and 31 with jejunal interposition. We compared complication rates, intensive care unit (ICU) and hospital stays, nutritional intake, number of tracheoesophageal punctures (TEPs) performed, TE speech fluency, and functional use. Modified barium swallow studies assessed swallowing physiology. Results: Patient characteristics were similar. Total flap loss occurred in one (3.7%) patient with an ALT flap and two (6.5%) patients with jejunal interposition (P = 1.000), fistula in two (7.4%) ALT patients and one (3.2%) jejunal patient (P =.5931), and anastomotic stricture in four (15%) ALT patients and six (19.4%) jejunal patients (P =.7371). ICU and hospital stays were greater for jejunal patients (P =.001, <.001, respectively). TEPs were performed in eight jejunal patients and nine ALT patients. Eighty-nine percent of ALT patients and 63% of jejunal patients were fluent, whereas 78% of ALT patients and 25% of jejunal patients used TE speech to communicate. Ninety-one percent of ALT patients and 73% of jejunal patients resumed oral intake (P =.151). The most common causes of dysphagia were impaired tongue base retraction (62% jejunum) and disordered motility (62% jejunum, 67% ALT). Conclusions. For circumferential pharyngoesophageal reconstruction, the ALT flap results in similar complication rates, but shorter ICU and hospital stays, and better speech and swallowing compared with jejunal reconstruction.
引用
收藏
页码:1266 / 1271
页数:6
相关论文
共 15 条
[1]   Voice restoration after circumferential pharyngolaryngectomy with free jejunum repair [J].
Benazzo, M ;
Bertino, G ;
Lanza, L ;
Occhini, A ;
Mira, E .
EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY, 2001, 258 (04) :173-176
[2]   Analysis of pharyngocutaneous fistula following free jejunal transfer for total laryngopharyngectomy [J].
Chang, DW ;
Hussussian, C ;
Lewin, JS ;
Youssef, AA ;
Robb, GL ;
Reece, GP .
PLASTIC AND RECONSTRUCTIVE SURGERY, 2002, 109 (05) :1522-1527
[3]   JEJUNAL FREE AUTOGRAFT - ANALYSIS OF COMPLICATIONS AND THEIR RESOLUTION [J].
COLEMAN, JJ ;
TAN, KC ;
SEARLES, JM ;
HESTER, TR ;
NAHAI, F .
PLASTIC AND RECONSTRUCTIVE SURGERY, 1989, 84 (04) :589-595
[4]   Barium swallows after free jejunal transfer: Should they be performed routinely? [J].
Cordeiro, PG ;
Shah, K ;
Santamaria, E ;
Gollub, MJ ;
Singh, B ;
Shah, JP .
PLASTIC AND RECONSTRUCTIVE SURGERY, 1999, 103 (04) :1167-1175
[5]   Tracheoesophageal speech following laryngopharyngectomy and pharyngeal reconstruction [J].
Deschler, DG ;
Gray, ST .
OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA, 2004, 37 (03) :567-+
[6]   Microvascular reconstruction of the hypopharynx: Defect classification, treatment algorithm, and functional outcome based on 165 consecutive cases [J].
Disa, JJ ;
Pusic, AL ;
Hidalgo, DA ;
Cordeiro, PG .
PLASTIC AND RECONSTRUCTIVE SURGERY, 2003, 111 (02) :652-660
[7]   Swallowing dysfunction after chemoradiation for advanced squamous cell carcinoma of the head and neck [J].
Kotz, T ;
Costello, R ;
Li, Y ;
Posner, MR .
HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK, 2004, 26 (04) :365-372
[8]  
LEWIN JS, 2004, 13 ANN DYSPH RES SOC
[9]  
LEWIN JS, 1998, J MED SPEECH PATH, V6, P27
[10]  
MENDELSOHN M, 1993, ARCH OTOLARYNGOL, V119, P508