背景:关于全喉切除术和部分咽切除术(TLwPP)后最有效的重建尚无共识。本研究旨在比较不同的重建技术(胸大肌肌皮瓣,PMMCF;股前外侧皮瓣,ALTF;前臂桡侧游离皮瓣,RFFF)在咽部皮肤瘘(PCF)方面的TLwPP后,狭窄和喂养管依赖(FTD)的发生率。
方法:Scopus,PubMed/MEDLINE,科克伦图书馆,搜索了谷歌学者数据库。对PCF发生率进行了单臂荟萃分析,狭窄发生率,和FTD在整个队列中的发病率。进行了基于手臂的网络分析,以比较三种不同的手术干预措施(PMMCF,ALTF,RFFF)。
结果:共有13项研究和232例患者纳入网络meta分析。RFFF的PCF绝对风险最低(11.7%,95%CI:2.8%-33.4%),与ALTF(13.4%,95%CI:4.5%-32.1%)和PMMC(49.0%,95%CI:19.2%-79.3%)。RFFF显示狭窄绝对风险为0.0%(95%CI:0.0%-1.1%),而ALTF的狭窄发生率较高(5.7%,95%CI:0.8%-25.2%)和PMMCF(11.6%,95%CI:0.8%-55.1%)。RFFF显示FTD发病率的绝对风险最低(6.8%,95%CI:0.5%-28.1%)与其他重建技术(PMMCF:12.4%,95%CI:2.4%-42.1%;ALTF:17.5%,95%CI:6.4%-38.9%)。
结论:由于PCF的发生率较低,RFFF似乎是TLwPP术后部分咽缺损重建的最佳选择,与ALTF和PMMCF相比,狭窄和FTD。
BACKGROUND: No consensus exists regarding the most effective reconstruction after total laryngectomy with partial pharyngectomy (TLwPP). This study aims to compare different reconstructive techniques (pectoralis major myo-cutaneous flap, PMMCF; anterolateral thigh flap, ALTF; radial forearm free flap, RFFF) after TLwPP in terms of pharyngocutaneous fistula (PCF), stenosis and feeding tube dependence (FTD) incidence.
METHODS: The Scopus, PubMed/MEDLINE, Cochrane Library, and Google Scholar databases were searched. A single-arm meta-analysis was performed for PCF incidence, stenosis incidence, and FTD incidence on the entire cohort. An arm-based network analysis was conducted to compare three different surgical interventions (PMMCF, ALTF, RFFF).
RESULTS: A total of 13 studies and 232 patients were included in the network meta-analysis. The lowest PCF absolute risk was measured for the RFFF (11.7%, 95% CI: 2.8%-33.4%), compared to the ALTF (13.4%, 95% CI: 4.5%-32.1%) and the PMMC (49.0%, 95% CI: 19.2%-79.3%). The RFFF showed a stenosis absolute risk of 0.0% (95% CI: 0.0%-1.1%), while a higher stenosis incidence was measured for the ALTF (5.7%, 95% CI: 0.8%-25.2%) and the PMMCF (11.6%, 95% CI: 0.8%-55.1%). The RFFF showed the lowest absolute risk of FTD incidence (6.8%, 95% CI: 0.5%-28.1%) compared to the other reconstructive techniques (PMMCF: 12.4%, 95% CI: 2.4%-42.1%; ALTF: 17.5%, 95% CI: 6.4%-38.9%).
CONCLUSIONS: The RFFF seems the best choice for reconstruction of partial pharyngeal defects after TLwPP due to the lower incidence of PCF, stenosis and FTD compared to the ALTF and the PMMCF.