全环状咽喉切除术后游离皮瓣重建的吞咽与发声功能结果：一项系统综述
Swallowing and vocal functional results after total circular pharyngolaryngectomy free-flap reconstruction: A systematic review.
文献信息
| PMID | 42977615 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | J Wijnen |
| 作者单位 | Service d'ORL et de chirurgie cervico-faciale, CHU de Nantes, Nantes, France. Electronic address: jules.wijnen@chu-orleans.fr. |
| 期刊 | European annals of otorhinolaryngology, head and neck diseases |
| SCI 分区 | Q2 |
| IF | 1.7 |
| 研究类型 | 综述 Meta · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
引言： 全环状咽喉切除术后的游离皮瓣重建旨在恢复吞咽和发声。然而，功能结果因皮瓣类型和手术技术而异，目前尚无共识性建议。
材料与方法： 按照PRISMA指南进行了一项系统综述。纳入报告全环状咽喉切除术后采用游离皮瓣重建的吞咽和/或发声功能结果的研究。由于方法学异质性妨碍了荟萃分析，数据以描述性方式综合。
结果： 分析了71项研究，涉及超过3800例患者。功能性吞咽的平均率为87%，在消化道具皮瓣（JFF、ICFF、GOFF）中更高。发声恢复平均为60%，在包含发声管或分流道的皮瓣（RFFPT、ICFF、带分流道的JFF）中更高。筋膜皮瓣（ALT、RFF）在吞咽和发声方面均提供了令人满意的功能结果。
结论： 消化道具皮瓣似乎更适合优化吞咽，而包含发声分流道的技术以更复杂的手术为代价改善了发声恢复。筋膜皮瓣在吞咽和嗓音质量方面提供了良好的权衡。研究的异质性和缺乏标准化限制了建议的强度。需要多中心前瞻性研究来证实这些发现。
英文摘要
INTRODUCTION: Free-flap reconstruction after total circular pharyngolaryngectomy aims to restore swallowing and phonation. However, functional outcomes vary depending on type of flap and surgical technique, and no consensus recommendations currently exist.
MATERIALS AND METHODS: A systematic review was conducted following PRISMA guidelines. Studies reporting functional outcomes for swallowing and/or phonation after total circular pharyngolaryngectomy reconstructed with free flaps were included. Data were synthesized descriptively, as methodological heterogeneity precluded meta-analysis.
RESULTS: Seventy-one studies, for more than 3800 patients, were analyzed. The mean rate of functional swallowing was 87%, and was higher with digestive flaps (JFF, ICFF, GOFF). Voice recovery averaged 60%, with higher rates for flaps incorporating a phonatory tube or shunt (RFFPT, ICFF, JFF with shunt). Fasciocutaneous flaps (ALT, RFF) provided satisfactory functional outcomes for both swallowing and phonation.
CONCLUSION: Digestive flaps appeared to be preferable for optimizing swallowing, whereas techniques incorporating a phonatory shunt improved voice recovery at the cost of a more complex procedure. Fasciocutaneous flaps provided a good trade-off for swallowing and voice quality. The heterogeneity of the studies and lack of standardization limited the strength of the recommendations. Multicenter prospective studies are needed to confirm these findings.