Background: Various operative techniques exist to reconstruct partial hypopharyngeal defects following total laryngectomy. The current study aimed to investigate and compare complications and functional results following commonly used reconstructive techniques. Methods: A systematic review and meta-analysis were performed using studies that investigated outcomes after the reconstruction of a partial hypopharyngeal defect. The outcomes of interest were fistulas, strictures, flap failure, swallowing function and postoperative speech. Results: Of the 4035 studies identified, 23 were included in this review. Four common reconstructive techniques were reported, with a total of 794 patients: (1) pectoralis major myocutaneous and (2) myofascial flap, (3) anterolateral thigh free flap and (4) radial forearm free flap. Fistulas occurred significantly more often than pectoralis major myocutaneous flaps (34%, 95% CI 23–47%) compared with other flaps (p< 0.001). No significant differences in the rates of strictures or flap failure were observed. Pectoralis major myofascial flaps were non-inferior to free-flap reconstructions. Insufficient data were available to assess speech results between flap types. Conclusion: Pectoralis myocutaneous flaps should not be the preferred method of reconstruction for most patients, considering their significantly higher rate of fistulas. In contrast, pectoralis major myofascial flaps yield promising results compared to free-flap reconstructions, warranting further investigation.
背景：全喉切除术后存在多种重建部分下咽缺损的手术技术。本研究旨在调查并比较常用重建技术的并发症及功能结果。方法：通过系统综述和荟萃分析，纳入研究部分下咽缺损重建后疗效的文献。重点关注瘘管、狭窄、皮瓣坏死、吞咽功能及术后言语功能等结局指标。结果：在检索到的4035篇文献中，共纳入23项研究。文献报道了四种常用重建技术，涉及794例患者：（1）胸大肌肌皮瓣，（2）胸大肌肌筋膜瓣，（3）股前外侧游离皮瓣，（4）前臂桡侧游离皮瓣。与其他皮瓣相比，胸大肌肌皮瓣的瘘管发生率显著更高（34%，95% CI 23–47%）（p<0.001）。狭窄率与皮瓣坏死率未见显著差异。胸大肌肌筋膜瓣的疗效不劣于游离皮瓣重建。现有数据不足以评估不同皮瓣类型的言语功能差异。结论：鉴于胸大肌肌皮瓣的瘘管发生率显著更高，对多数患者而言不应作为首选重建方案。相比之下，胸大肌肌筋膜瓣较游离皮瓣重建展现出良好前景，值得进一步研究。
肿瘤(癌症)患者之家