双凸缘语音假体预防假体周围渗漏:一项系统综述和管理方案建议。

Pub Date : 2023-10-01 Epub Date: 2022-02-25 DOI:10.1080/14015439.2022.2042595
Miguel Mayo-Yáñez, Irma Cabo-Varela, Christian Calvo-Henríquez, Carlos Chiesa-Estomba, Jesús Herranz González-Botas
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引用次数: 4

摘要

目的:对Provox®VegaTMXtraSealTM在预防假体周围渗漏方面的使用和结果进行系统回顾,并提出该语音假体的管理方案。方法:根据2020年2月PRISMA声明进行系统检索。关键词为双凸缘、假体周围渗漏、发音假体和喉切除术。结果:在55例患者中发现4篇文章,共315个假声(94个XtraSeal和221个对照)。XtraSeal的平均持续时间为114.28 ± 73.2天(CI 95%,98.29-130.26),而102.98天 ± 对照组为17.74天(CI 95%,100.62-105.35)。在266次置换中,两组中最常见的原因是假体内渗漏(62.41%)。XtraSeal的假体周围渗漏发生率(9.62%)低于对照组(22.43%)。有必要采用稳健的方法进行研究以证实这些结果。语音假体的管理非常复杂,需要经验丰富的专业人员采取多学科和系统的方法来减少更换和并发症。XtraSeal放置不当可能导致异物反应,从而导致炎症、挤压或压力损伤。Hercules之塔方案:(1)使用Provox®测量仪测量气管食管瘘,(2)通过避免假体蓝环的完全可视化来最小化XtraSeal松弛,(3)食道壁的鼻纤维镜检查,确认两个凸缘都处于正确位置;可以预防或尽量减少使用XtraSeal引起的并发症。
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Prevention of periprosthetic leakage with double flange voice prosthesis: a systematic review and management protocol proposal.

Objective: To conduct a systematic review of the use and results of the Provox®VegaTMXtraSealTM in the prevention of periprosthetic leakage and to propose a management protocol for this voice prosthesis.

Methods: Systematic search based on the PRISMA Statement during February 2020. Keywords were double flange, periprosthetic leakage, voice prosthesis, and laryngectomy.

Results: Four articles with 315 voice prosthesis (94 XtraSeal and 221 controls) in 55 patients were found. The XtraSeal mean duration was 114.28 ± 73.2 (CI 95%, 98.29-130.26) days compared to 102.98 ± 17.74 (CI 95%, 100.62-105.35) days of the control group. Out of 266 replacements, endoprosthetic leakage was the most frequent cause in both groups (62.41%). Periprosthetic leaks were less frequent in the XtraSeal (9.62%) than in the control group (22.43%).

Conclusions: The XtraSeal could be effective in preventing periprosthetic leakage and lengthening the time between replacements. Studies with a robust methodology are necessary to confirm these results. Managing voice prosthesis is complex and requires a multidisciplinary and systematic approach by experienced professionals to reduce replacements and complications. Incorrect placement of the XtraSeal could cause a foreign body reaction and consequently inflammation, extrusion, or pressure lesions. The Tower of Hercules protocol: (1) Measurement of the tracheoesophageal fistula using the Provox® Measure, (2) Minimization of XtraSeal slack by avoiding the complete visualization of the prosthesis' blue ring, (3) Nasofibroscopic examination of the oesophageal wall confirming both flanges are in correct position; could prevent or minimize complications derived from the use of the XtraSeal.

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