Study of pharyngocutaneous fistula after total laryngectomy
We investigated the incidence and risk factors of pharyngocutaneous fistula (PCF) after total laryngectomy. The study subjects were 36 patients who had received total laryngectomy at Miyazaki University Hospital between April 1, 2013, and December 31, 2019. PCF developed in 9 patients (25%). This ra...
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| Published in | jibi to rinsho Vol. 67; no. 1; pp. 13 - 18 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
JIBI TO RINSHO KAI
20.01.2021
耳鼻と臨床会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0447-7227 2185-1034 |
| DOI | 10.11334/jibi.67.1_13 |
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| Abstract | We investigated the incidence and risk factors of pharyngocutaneous fistula (PCF) after total laryngectomy. The study subjects were 36 patients who had received total laryngectomy at Miyazaki University Hospital between April 1, 2013, and December 31, 2019. PCF developed in 9 patients (25%). This rate was even higher among patients with diabetes (3/6 ; 50%). However, we should have evaluated the disease severity of diabetes at the degree of the tissue disorder, and not at the blood sugar level. The incidence of PCF in salvage cases was 31.6% (6/19). As a result, we concluded that the operation using the prophylactic flaps for all salvage cases was somewhat excessive. In the future, we will continue to deal with the PCF by early treatment. |
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| AbstractList | We investigated the incidence and risk factors of pharyngocutaneous fistula (PCF) after total laryngectomy. The study subjects were 36 patients who had received total laryngectomy at Miyazaki University Hospital between April 1, 2013, and December 31, 2019. PCF developed in 9 patients (25%). This rate was even higher among patients with diabetes (3/6 ; 50%). However, we should have evaluated the disease severity of diabetes at the degree of the tissue disorder, and not at the blood sugar level. The incidence of PCF in salvage cases was 31.6% (6/19). As a result, we concluded that the operation using the prophylactic flaps for all salvage cases was somewhat excessive. In the future, we will continue to deal with the PCF by early treatment. We investigated the incidence and risk factors of pharyngocutaneous fistula (PCF) after total laryngectomy. The study subjects were 36 patients who had received total laryngectomy at Miyazaki University Hospital between April 1, 2013, and December 31, 2019. PCF developed in 9 patients (25%). This rate was even higher among patients with diabetes (3/6 ; 50%). However, we should have evaluated the disease severity of diabetes at the degree of the tissue disorder, and not at the blood sugar level. The incidence of PCF in salvage cases was 31.6% (6/19). As a result, we concluded that the operation using the prophylactic flaps for all salvage cases was somewhat excessive. In the future, we will continue to deal with the PCF by early treatment. 当科で 2013 年 4 月から 2019 年 12 月の 6 年 9 カ月間に喉頭全摘出術を行い、残存咽頭粘膜を一次縫合して閉創した 36 例について、咽頭皮膚瘻の発生率と危険因子について検討した。発生率は 25％（9/36 例）であった。糖尿病合併例では 50％（3/6 例）と高いが、評価においては診断名や血糖値ではなく、組織の血行障害の程度による病態でのリスクの把握に努めるべきであった。救済手術例での発生率は 31.6％（6/19 例）で、救済手術例全例への血流豊富な皮弁による予防的被覆の適用は過剰と考え、引続き早期処置で対応する方針とした。 |
| Author | KAJIHARA, Kei OKUDA, Takumi KAWABATA, Takayuki TONO, Tetsuya IDE, Shinsuke |
| Author_FL | 奥田 匠 川畑 隆之 井手 慎介 梶原 啓 東野 哲也 |
| Author_FL_xml | – sequence: 1 fullname: 奥田 匠 – sequence: 2 fullname: 井手 慎介 – sequence: 3 fullname: 梶原 啓 – sequence: 4 fullname: 川畑 隆之 – sequence: 5 fullname: 東野 哲也 |
| Author_xml | – sequence: 1 fullname: IDE, Shinsuke organization: Department of Otolaryngology-Head and Neck Surgery, Miyazaki University – sequence: 1 fullname: TONO, Tetsuya organization: Department of Otolaryngology-Head and Neck Surgery, Miyazaki University – sequence: 1 fullname: KAJIHARA, Kei organization: Department of Otolaryngology-Head and Neck Surgery, Miyazaki University – sequence: 1 fullname: OKUDA, Takumi organization: Department of Otolaryngology-Head and Neck Surgery, Miyazaki University – sequence: 1 fullname: KAWABATA, Takayuki organization: Department of Otolaryngology, Miyazaki Prefectural Miyazaki Hospital |
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| DocumentTitleAlternate | 喉頭全摘出術後の咽頭皮膚瘻症例の検討 |
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| References | 15) Cavalot AL et al : Pharyngocutaneous fistula as a complication of total laryngectomy − Review of the literature and analysis of case records −. Otolaryngol Head Neck Surg 123 : 587-592, 2000. 4) Ji-Wang Liang et al : Pharyngocutaneous Fistula After Total Laryngectomy − A Systematic Review and Meta-Analysis of Risk Factors −. Auris Nasus Larynx 42 : 353-359, 2015. 6) Paolo Boscolo-Rizzo et al : Multivariate analysis of risk factors for pharyngocutaneous Wstula after total laryngectomy. Eur Arch Otorhinolaryngol 265 : 929‒936, 2008. 18) 新井善雄 他 ： Albert − Lembert 法および Gambee 法における小腸吻合部 組織血流量について − 脱血負荷黄疸犬を中心に −．日消外会誌 20 ： 2730-2734，1987 12) 日本糖尿病眼学会 ： ガイドラインその他 糖尿病網膜症について． https://www.jsod.jp/member/guideline.html （2020.5.29） 11) 緒方奈保子 ・ 松村美代 ： 身体診察法と異常所見の診方 X．眼底検査．日内会誌 89 ： 71-80，2000 16) 小川 徹 他 ： 喉頭・下咽頭の手術 進行喉頭癌 喉頭全摘出術 − 咽頭皮膚瘻孔への早期対応のために −．耳喉頭頸 87 ： 235-238，2015 1) 日本糖尿病学会 ： 2 糖尿病治療と目標の指針．糖尿病診療ガイドライン 2019．日本糖尿病学会 編，25 頁，南江堂，東京，2019 3) 篠崎 剛 他 ： 喉頭全摘出後咽頭皮膚瘻についての検討．頭頸部外科 17 ： 249-254，2008 14) Hier M et al : Pharygo-cutaneous fistula after laryngectomy − Incidence, etiology and outcome analysis −. J Otolaryngol 22 : 164-166, 1993. 2) 中溝宗永 他 ： 喉頭全摘出術後の咽頭皮膚瘻 . 日耳鼻 100 ： 213-219，1997 5) Mark Sayles and David G Grant : Preventing pharyngo-cutaneous fistula in total laryngectomy − A systematic review and meta-analysis −. Laryngoscope 124 : 1150‒1163, 2014. 9) Jacopo Galli et al : Stapler Use in Salvage Total Laryngectomy − A Useful Tool? −. Laryngoscope 131 : E473-E478, 2021. 7) Mattioli F et al : Analysis of risk factors for pharyngocutaneous fistula after total laryngectomy with particular focus on nutritional status. Acta Otorhinolaryngol Ital 35 : 243‒248, 2015. 13) Mcmillan DE : Deterioration of the microcirculation in diabetes. Diabetes 24 : 944-957, 1975. 17) 鈴木政美 ： 喉頭全摘出術後の咽頭皮膚瘻への対応．JOHNS 31 ： 507-510，2015 10) 木原信市 他 ： 糖尿病合併消化器疾患の術前・術後合併症 特に糖尿病歴、重症度からみた検討．日消外会誌 19 ： 815-818，1986 8) MahmutDeniz et al : Pharyngoesophageal Suturing Technique May Decrease the Incidence of Pharyngocutaneous Fistula following Total Laryngectomy. Hindawi Publishing Corporation Surgery Research and Practice Volume 2015, Article ID 363640, 5 pages http://dx.doi.org/10.1155/2015/363640 |
| References_xml | – reference: 9) Jacopo Galli et al : Stapler Use in Salvage Total Laryngectomy − A Useful Tool? −. Laryngoscope 131 : E473-E478, 2021. – reference: 18) 新井善雄 他 ： Albert − Lembert 法および Gambee 法における小腸吻合部 組織血流量について − 脱血負荷黄疸犬を中心に −．日消外会誌 20 ： 2730-2734，1987． – reference: 17) 鈴木政美 ： 喉頭全摘出術後の咽頭皮膚瘻への対応．JOHNS 31 ： 507-510，2015． – reference: 3) 篠崎 剛 他 ： 喉頭全摘出後咽頭皮膚瘻についての検討．頭頸部外科 17 ： 249-254，2008． – reference: 6) Paolo Boscolo-Rizzo et al : Multivariate analysis of risk factors for pharyngocutaneous Wstula after total laryngectomy. Eur Arch Otorhinolaryngol 265 : 929‒936, 2008. – reference: 16) 小川 徹 他 ： 喉頭・下咽頭の手術 進行喉頭癌 喉頭全摘出術 − 咽頭皮膚瘻孔への早期対応のために −．耳喉頭頸 87 ： 235-238，2015． – reference: 5) Mark Sayles and David G Grant : Preventing pharyngo-cutaneous fistula in total laryngectomy − A systematic review and meta-analysis −. Laryngoscope 124 : 1150‒1163, 2014. – reference: 15) Cavalot AL et al : Pharyngocutaneous fistula as a complication of total laryngectomy − Review of the literature and analysis of case records −. Otolaryngol Head Neck Surg 123 : 587-592, 2000. – reference: 4) Ji-Wang Liang et al : Pharyngocutaneous Fistula After Total Laryngectomy − A Systematic Review and Meta-Analysis of Risk Factors −. Auris Nasus Larynx 42 : 353-359, 2015. – reference: 11) 緒方奈保子 ・ 松村美代 ： 身体診察法と異常所見の診方 X．眼底検査．日内会誌 89 ： 71-80，2000． – reference: 8) MahmutDeniz et al : Pharyngoesophageal Suturing Technique May Decrease the Incidence of Pharyngocutaneous Fistula following Total Laryngectomy. Hindawi Publishing Corporation Surgery Research and Practice Volume 2015, Article ID 363640, 5 pages http://dx.doi.org/10.1155/2015/363640 – reference: 7) Mattioli F et al : Analysis of risk factors for pharyngocutaneous fistula after total laryngectomy with particular focus on nutritional status. Acta Otorhinolaryngol Ital 35 : 243‒248, 2015. – reference: 13) Mcmillan DE : Deterioration of the microcirculation in diabetes. Diabetes 24 : 944-957, 1975. – reference: 1) 日本糖尿病学会 ： 2 糖尿病治療と目標の指針．糖尿病診療ガイドライン 2019．日本糖尿病学会 編，25 頁，南江堂，東京，2019． – reference: 2) 中溝宗永 他 ： 喉頭全摘出術後の咽頭皮膚瘻 . 日耳鼻 100 ： 213-219，1997． – reference: 12) 日本糖尿病眼学会 ： ガイドラインその他 糖尿病網膜症について． https://www.jsod.jp/member/guideline.html （2020.5.29） – reference: 14) Hier M et al : Pharygo-cutaneous fistula after laryngectomy − Incidence, etiology and outcome analysis −. J Otolaryngol 22 : 164-166, 1993. – reference: 10) 木原信市 他 ： 糖尿病合併消化器疾患の術前・術後合併症 特に糖尿病歴、重症度からみた検討．日消外会誌 19 ： 815-818，1986． |
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| SubjectTerms | 化学放射線療法 咽頭皮膚瘻 喉頭全摘出術 救済手術 糖尿病 |
| Title | Study of pharyngocutaneous fistula after total laryngectomy |
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