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Laryngorhinootologie 2018; 97(02): 100-109
DOI: 10.1055/s-0043-122746
Originalarbeit
Georg Thieme Verlag KG Stuttgart · New York

Mikrovaskuläre Kehlkopfrekonstruktion nach totaler Laryngektomie

Microvascular reconstruction of the larynx following total laryngectomy
Stephan Hackenberg
,
Norbert Kleinsasser
,
Agmal Scherzad
,
Fabian Kraus
,
Rudolf Hagen
Further Information

Publication History

09/07/2017

11/01/2017

Publication Date:
29 November 2017 (online)

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Zusammenfassung

Die totale Laryngektomie stellt nach wie vor ein Standardverfahren zur Therapie fortgeschrittener Larynx- und Hypopharynxkarzinome dar. Der Verlust des stimmbildenden Organs schränkt die Lebensqualität der Betroffenen maßgeblich ein. Die am häufigsten eingesetzte Technik zur Stimmrehabilitation ist die tracheoösophageale Punktion mit Einsatz eines Stimmventils. Zu den chirurgischen Verfahren der Stimmrehabilitation gehört unter anderem die Larynxrekonstruktion mit einem Unterarmlappen. Im Rahmen dieser monozentrischen retrospektiven Analyse wurden Patienten betrachtet, die zwischen 2006 und 2015 nach totaler Laryngektomie mit einer solchen sogenannten Laryngoplastik versorgt wurden. Fokus der Untersuchung lag auf der Beurteilung von funktionellen Langzeitergebnissen und Komplikationen. Insgesamt konnten 39 Patienten in die Studie eingeschlossen werden, von denen bei 77 % eine dauerhafte Phonation über das Transplantat möglich war, bei 62 % sogar fingerfrei. Nach Ausschluss adjuvant bestrahlter Patienten lag die Rate der erfolgreichen Stimmrehabilitation bei 91 % (20 / 22). Das postoperative Halshämatom war mit 15 % die häufigste Frühkomplikation, Lappennekrosen traten nicht auf. Die häufigste Spätkomplikation war die Stenosierung des Laryngoplastiklumens, welche in der Regel als Folge einer Radiatio auftrat. Im Vergleich zu Daten aus der Literatur ist die Rate erfolgreich stimmrehabilitierter Patienten annähernd gleichwertig zur Versorgung mit einem Stimmventil, allerdings mit qualitativ besseren Ergebnissen. Komplikationen, die durch das Stimmventil bedingt sind und in seltenen Fällen schwerwiegend sein können, treten bei Laryngoplastikpatienten nicht auf. Die lebenslange Notwendigkeit zum regelmäßigen Stimmventilwechsel entfällt. Bei korrekter Indikationsstellung ist die Laryngoplastik eine suffiziente Methode zur Stimmrehabilitation nach Laryngektomie.

Abstract

Total laryngectomy still is a standard procedure for the treatment of advanced laryngeal or hypopharyngeal carcinoma. The unavoidable loss of voice may lead to serious impairments in quality of life. The most common technique of voice restoration is the tracheal-esophageal puncture combined with the application of a voice prosthesis. Laryngeal reconstruction with a radial forearm flap represents a possible surgical method of voice restoration. This study is a mono-center retrospective analysis of patients receiving a so-called laryngoplasty after total laryngectomy between 2006 and 2015, focusing on long-term functional outcome and complications. 39 patients were included. Sufficient phonation was possible in 77 %, finger-free speaking was achieved in 62 %. Exclusion of irradiated patients revealed a rehabilitation rate of 91 %. The most common early complication was cervical hematoma in 15 %, whereas no loss of flap was assessed. Stenosis of the laryngoplasty was seen in 7 cases, mainly post-irradiation. The rate of successful voice restoration is equal in both, laryngoplasty and voice prosthesis patients. However, voice quality is better after surgical reconstruction. Complications induced by the voice prosthesis, which may be severe in some cases, were not seen in the study group. Furthermore, life-long support by an ENT specialist regarding voice prosthesis exchange is not necessary. Assuming correct choice of candidates, laryngoplasty is a sufficient method for voice restoration after laryngectomy.

Schlüsselwörter

totale Laryngektomie - Stimmrehabilitation - Unterarmlappen - Laryngoplastik - Kehlkopfrekonstruktion

Key words

total laryngectomy - voice restoration - radial forearm flap - laryngoplasty - reconstruction of larynx
 

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