全喉切除术后早期口服泛影葡胺后立即行CT检查以精确定位瘘口并制定手术方案

文献信息

中文摘要

目的： 咽皮肤瘘（PCF）是全喉切除术后最常见且具有临床意义的并发症，常导致恢复延迟和发病率增加。准确、早期地发现咽部瘘口至关重要；然而，传统影像学方法如造影吞咽检查和计算机断层扫描（CT）在精确解剖定位方面存在局限。
材料与方法： 本回顾性队列研究纳入2020年1月至2025年12月期间接受全喉切除术的117例患者。根据术后影像学方案将患者分为两组：泛影葡胺吞咽后立即行CT（泛影葡胺-CT组，n=22）和传统影像学检查（n=95）。采用四点序数量表评估瘘口定位，并将具有手术可操作性的定位定义为评分≥2。同时评估临床结局及对治疗管理的影响。
结果： 与传统影像学检查相比，泛影葡胺-CT方案显著改善了瘘口定位（平均定位评分：3.00±0.00 vs. 1.62±0.83，p=0.01）。泛影葡胺-CT组所有患者均实现了具有手术可操作性的定位，而传统组为51.2%（p=0.03）。泛影葡胺-CT组100%的患者在初次影像学检查中即发现瘘口，而传统组为82.9%。尽管临床结局（包括经口进食时间、并发症发生率和住院时间）无显著差异，但泛影葡胺-CT方案提供了更精确的解剖勾画，有助于制定针对性的手术方案。
结论： 口服泛影葡胺吞咽后立即行CT可显著改善全喉切除术后咽部瘘口的解剖定位。通过在单次影像学检查中整合瘘口检测和解剖勾画，该方案增强了手术决策，并可作为PCF术后评估和管理的实用辅助手段。
证据等级： 3。

英文摘要

PURPOSE: Pharyngocutaneous fistula (PCF) is the most common and clinically significant complication following total laryngectomy, often leading to delayed recovery and increased morbidity. Accurate and early detection of pharyngeal leak is critical; however, conventional imaging modalities such as contrast swallow studies and computed tomography (CT) have limitations in precise anatomical localization.
MATERIALS AND METHODS: This retrospective cohort study included 117 patients who underwent total laryngectomy between January 2020 and December 2025. Patients were divided into two groups according to the postoperative imaging protocol: Gastrografin swallow followed by immediate CT (Gastrografin-CT group, n = 22) and conventional imaging (n = 95). Leak localization was assessed using a four-point ordinal scale, and surgically actionable localization was defined as a score ≥ 2. Clinical outcomes and impact on management were also evaluated.
RESULTS: The Gastrografin-CT protocol demonstrated significantly improved leak localization compared with conventional imaging (mean localization score: 3.00 ± 0.00 vs. 1.62 ± 0.83, p = 0.01). Surgically actionable localization was achieved in all patients in the Gastrografin-CT group compared with 51.2% in the conventional group (p = 0.03). Leaks were identified on initial imaging in 100% of patients in the Gastrografin-CT group versus 82.9% in the conventional group. Although clinical outcomes, including time to oral feeding, complication rates, and hospital stay, did not significantly differ, the Gastrografin-CT protocol provided more precise anatomical delineation, facilitating targeted surgical planning.
CONCLUSION: Performing CT immediately after an oral Gastrografin swallow significantly improves anatomical localization of pharyngeal leaks following total laryngectomy. By integrating leak detection and anatomical delineation in a single imaging session, this protocol enhances surgical decision-making and may serve as a practical adjunct for postoperative evaluation and management of PCF.
LEVEL OF EVIDENCE: 3.