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挽救喉切除术的重建与有限的喉切除术
Mauricio A Moreno1, Mark K Wax2, James Reed Gardner1
1Division of Head and Neck Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock.
JAMA otolaryngology-- head & neck surgery
|April 18, 2024
概括
与初级关闭 (PC) 或区域关闭 (RC) 相比,自由组织转移 (FTT) 关闭技术在救援喉切除术后显著降低了喉 (PCF) 风险. 这种技术没有影响功能结果,为头癌患者提供了更安全的选择.
科学领域:
- 头部和部手术 头部和部手术
- 手术瘤学手术瘤学
- 重建性手术是一种重建性手术.
背景情况:
- 挽救喉腔切除术关闭技术是为优化结果而辩论的.
- 头部和部外科医生寻求改善术后和功能结果的方法.
研究的目的:
- 调查救援喉腔切除术关闭技术与早期术后/功能结果之间的关联.
- 为了比较一次性粘膜关闭 (PC),区域关闭 (RC) 和自由组织转移 (FTT) 在救援喉切除术中.
主要方法:
- 对来自17个三级保健中心的309名患者进行了回顾性队列研究 (2011-2016).
- 患者在放射治疗/化学放射治疗后接受了全喉切除术和有限喉切除术.
- 用PC,RC或FTT重建的喉缺陷;使用多变量回归分析的结果.
主要成果:
- 自由组织转移 (FTT) 在52.1%的患者中使用,区域关闭 (RC) 在20.7%,初级关闭 (PC) 在27.2%.
- 皮性 (PCF) 的发生率为FTT的22.4%,RC的39.1%,PC的34.5%.
- 多变量分析显示PCF风险较高,PC (RR,2.2) 和RC (RR,2.5) 与FTT相比. FTT降低了PCF的风险 (RR, 0.6;NNT, 7).
- 两组之间没有观察到功能结果的显著差异.
结论:
- 插座皮关闭 (FTT) 与在救援喉切除术设置中PCF风险降低有关.
- 在学术实践中,FTT是管理有限喉缺陷的最常见技术.
- 关闭技术在术后1年和2年没有影响功能结果.
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