Tracheojejunal fistulization for voice reconstruction following pharyngo-laryngoesophagectomy.

概要

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Over the past 10 years, a total of 20 patients underwent the tracheojejunal fistulization for voice reconstruction following pharyngolaryngoesophagectomy with free jejunum reconstruction for advanced hypopharyngeal cancer. For voice reconstruction, a 2-cm inferiorly based tracheal flap was obtained from the membranous part of the trachea by removing 4 cartilaginous tracheal rings. After the completion of digestive continuity with the jejunal autograft, a side-to-side anastomosis was created by approximating the incised margin of the transplanted jejunal mucosa to that of the tracheal flap. The tracheal flap was tubed to construct the tracheojejunal fistula. The incised margin of the transplanted jejunal serosa was additionally sutured to the lateral wall of the fistula to reinforce the approximation of the fistula and the transplanted jejunum. Sixteen (80%) of 20 patients retained phonatory function. Patients with the tracheojejunal phonation could speak at 1 month postoperatively on average. The average value of maximum phonation time in 16 tracheojejunal speakers was 11 seconds. As far as the swallowing function is concerned, fifteen of 16 patients could swallow without aspiration problem.
日本頭頸部癌学会の論文