改良负压封闭引流装置在难治性咽瘘治疗中的应用

doi:10.6040/j.issn.1673-3770.0.2020.044

摘要/Abstract

摘要： 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。

关键词: 难治性咽瘘, 负压封闭引流, 下咽癌, 喉癌

Abstract: 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 T2N2M0)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.

Key words: Refractory pharyngocutaneous fistula, Vaccum sealing drainage, Hypopharyngeal cancinoma, Laryngeal cancinoma

中图分类号:

R767

崔小缓,李丽娜,张延平,蒋兴旺,毕欣欣,冉桃桃,吴莹莹,刘雅莉. 改良负压封闭引流装置在难治性咽瘘治疗中的应用[J]. 山东大学耳鼻喉眼学报, 2020, 34(6): 49-53.

CUI Xiaohuan, LI Lina, ZHANG Yanping, JIANG Xingwang, BI Xinxin, RAN Taotao, WU Yingying, LIU Yali. Application of the improved vacuum sealing drainage device in the treatment of refractory pharyngocutaneous fistula[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(6): 49-53.

参考文献

[1] Liang JW, Li ZD, Li SC, et al. Pharyngocutaneous fistula after total laryngectomy: a systematic review and meta-analysis of risk factors[J]. Auris Nasus Larynx, 2015, 42(5): 353-359. doi:10.1016/j.anl.2015.04.002.
[2] Fleischmann W, Strecker W, Bombelli M, et al. Vacuum sealing as treatment of soft tissue damage in open fractures[J]. Unfallchirurg, 1993, 96(9): 488-492.
[3] Qu J, Yan R, Wang L, et al. Free dermatoplasty combined with vacuum sealing drainage for the treatment of large-area soft tissue defects accompanied by bone exposure in the lower leg[J]. Exp Ther Med, 2013, 5(5): 1375-1380. doi:10.3892/etm.2013.999.
[4] Tang J, Guo WC, Yu L, et al. Clinical efficacy of artificial skin combined with vacuum sealing drainage in treating large-area skin defects[J]. Chin J Traumatol, 2010, 13(5): 289-292.
[5] 欧昌良, 邹永根, 罗成, 等. 负压封闭引流联合股前外侧穿支皮瓣修复足部软组织缺损[J]. 中国骨伤, 2018, 31(7): 666-670. doi:10.3969/j.issn.1003-0034.2018.07.015. OU Changliang, ZOU Yonggen, LUO Cheng, et al. Vacuum sealing drainage with anterolateral thigh perforator flap for repair foot soft tissue defect[J]. China Journal of Orthopaedics and Traumatology, 2018, 31(7): 666-670. doi:10.3969/j.issn.1003-0034.2018.07.015.
[6] 岳建林, 林云, 姜震, 等. 半侧舌根组织瓣在咽腔侧方缺损修复中的应用[J]. 山东大学耳鼻喉眼学报, 2020, 34(1): 63-66. doi:10.6040/j.issn.1673-3770.0.2019.502. YUE Jianlin, LIN Yun, JIANG Zhen, et al.Application of the hemi-tongue root flap for the repair of lateral defects in the pharyngeal cavity[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(1): 63-66. doi:10.6040/j.issn.1673-3770.0.2019.502.
[7] 高晨, 刘辉. 喉癌309例全喉切除术后咽瘘的危险因素分析[J]. 福建医药杂志, 2019, 41(6): 60-62.
[8] 王贺贺, 万光伦, 孙敬武, 等. 64例下咽癌患者术后生存分析[J]. 中国耳鼻咽喉颅底外科杂志, 2019, 25(4): 357-360. doi:10.11798/j.issn.1007-1520.201904006. WANG Hehe, WAN Guanglun, SUN Jingwu, et al. Analysis of postoperative survival in 64 patients with hypopharyngeal carcinoma[J]. Chinese Journal of Otorhinolaryngology-Skull Base Surgery, 2019, 25(4): 357-360.doi:10.11798/j.issn.1007-1520.201904006.
[9] 李文明, 魏东敏, 孙睿杰, 等. 下咽癌侵犯颈段食管的治疗[J]. 山东大学耳鼻喉眼学报, 2016, 30(3): 15-19. doi:10.6040/j.issn.1673-3770.0.2016.221. LI Wenming, WEI Dongmin, SUN Ruijie, et al. Surgical treatment of hypopharyngeal cancer with cervical esophageal invasion[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2016, 30(3): 15-19. doi:10.6040/j.issn.1673-3770.0.2016.221.
[10] 颜少观. 喉癌患者术后发生咽瘘的相关因素研究[J]. 中国社区医师, 2015, 31(36): 128-129. doi:10.3969/j.issn.1007-614x.2015.36.81. YAN Shaoguan. Study on the factors related to the postoperative pharyngeal fistula in patients with laryngeal cancer[J]. Chinese Community Doctors, 2015, 31(36): 128-129. doi:10.3969/j.issn.1007-614x.2015.36.81.
[11] Sayles M, Grant DG. Preventing pharyngo-cutaneous fistula in total laryngectomy: a systematic review and meta-analysis[J]. Laryngoscope, 2014, 124(5): 1150-1163.doi:10.1002/lary.24448.
[12] Narayan M, Limbachiya S, Balasubramanian D, et al. Efficacy of small-volume gastrografin videofluoroscopic screening for detecting pharyngeal leaks following total laryngectomy[J]. J Laryngol Otol, 2020, 134(4): 350-353. doi:10.1017/s0022215120000596.
[13] Aires FT, Dedivitis RA, Kulcsar MAV, et al. Neutrophil-to-lymphocyte ratio as a prognostic factor for pharyngocutaneous fistula after total laryngectomy[J]. Acta Otorhinolaryngol Italica,2018, 38(1): 31-37. doi:10.14639/0392-100X-1572.
[14] 钟克宣, 杨耿华, 何伟平, 等. 负压封闭引流技术在软组织损伤修复中的临床应用[J]. 吉林医学, 2014, 35(13): 2741-2742. doi:10.3969/j.issn.1004-0412.2014.13.009.
[15] 彭如辉, 郭力. 负压创面疗法在创面修复中的基础研究及临床应用进展[J]. 大家健康(中旬版), 2014, 8(10): 308-309.
[16] 王泽民, 蔡仲斌, 卢炯文. 封闭式负压引流在治疗深部感染中的效果观察[J]. 临床医学工程, 2018, 25(10): 1325-1326. doi:10.3969/j.issn.1674-4659.2018.10.1325.
[17] Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience[J]. Ann Plast Surg, 1997, 38(6): 563-577.
[18] Teixeira S, Costa J, Bartosch I, et al. Management of pharyngocutaneous fistula with negative-pressure wound therapy[J]. J Craniofacial Surg, 2017, 28(4): e364-e367. doi:10.1097/scs.0000000000003682.
[19] Loaec E, Vaillant PY, Bonne L, et al. Negative-pressure wound therapy for the treatment of pharyngocutaneous fistula[J]. Eur Ann Otorhinolaryngol Head Neck Dis, 2014, 131(6): 351-355. doi:10.1016/j.anorl.2013.12.001.
[20] 周斌, 庄秀妹, 陈伟良, 等. 折叠延长下斜方肌岛状皮瓣修复全喉切除术后巨大咽皮瘘8例报道[J]. 中国口腔颌面外科杂志, 2019, 17(2): 166-170. doi:10.19438/j.cjoms.2019.02.014.
[21] 宋达疆, 章一新, 李赞, 等. 改良带蒂胸肩峰动脉穿支皮瓣修复复杂咽瘘缺损: 九例经验总结[J]. 中华耳鼻咽喉头颈外科杂志, 2016, 51(12): 918-922. doi:10.3760/cma.j.issn.1673-0860.2016.12.008.
[22] 田媛. 负压封闭引流技术(VSD)在抗凝治疗患者慢性创面的临床应用研究[D]. 重庆: 中国人民解放军陆军军医大学, 2019
[23] Timmers MS, Le Cessie S, Banwell P, et al. The effects of varying degrees of pressure delivered by negative-pressure wound therapy on skin perfusion[J]. Ann Plast Surg, 2005, 55(6): 665-671. doi:10.1097/01.sap.0000187182.90907.3d.

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