HNO

, Volume 58, Issue 5, pp 497–505 | Cite as

Therapie der tracheoösophagealen und tracheopharyngealen Fisteln nach Laryngektomie

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Zusammenfassung

Tracheoösophageale (TÖF) und tracheopharyngeale Fisteln (TPF) nach Laryngektomie können in 5 Typen eingeteilt werden: „hohe TÖF bei defekter Stimmprothese“ (Typ Ia), „hohe TÖF mit Leckage neben der Stimmprothese“ (Typ Ib), „erweiterte hohe TÖF“ (Typ II), „tiefe TÖF“ (Typ III), „TPF“ (Typ IV) und „TPF assoziert mit einer Pharynxstenose“ (Typ V). TÖF-Leckagen nach prothetischer Stimmrehabilitation können gut konservativ behandelt werden. Bei allen TPF und in Fällen, in denen die konservative Behandlung versagt, ist ein chirurgisches Vorgehen mit einem transtracheostomalen oder transzervikalen mehrschichtigen Fistelverschluss erforderlich. Eine Trachea- bzw. Tracheostomaverlagerung zur Distanzierung der kranialen Trachea von den pharyngealen und ösophagealen Fistelnähten ist eine effektive Maßnahme für einen erfolgreichen Verschluss. In seltenen Fällen ist eine TPF mit einer narbigen Verengung des Pharynx kombiniert. Eine komplette Resektion des stenotischen pharyngoösophagealen Segments mit nachfolgender Rekonstruktion durch ein revaskularisiertes tubuläres Radialistransplantat kann in diesen Fällen indiziert sein.

Schlüsselwörter

Stimmprothese Tracheostomatransposition Pharynxrekonstruktion Pfeifenkopfplastik Tubuläres Radialistransplantat 

Treatment of tracheoesophageal and tracheopharyngeal fistulas after laryngectomy

Abstract

Tracheoesophageal (TEF) and tracheopharyngeal fistulas (TPF) after laryngectomy can mainly be divided into five types: “high TEF with leakage through the voice prosthesis (VP)” (Type Ia), “high TEF with leakage around the VP” (Type Ib), “enlarged high TEF” (Type II), “deep TEF” (Type III), “TPF” (Type IV) and “TPF associated with pharynx stenosis” (Type V). Leakage of TEF in prosthetic voice restoration usually responds well to conservative measures. If these measures fail, as well as in all cases of TPF, surgical intervention is necessary for transtracheostomal or transcervical closure with multi-layer sutures of the esophagus and trachea. In persisting TEF/TPF after unsuccessful surgical attempts revision surgery remains challenging. Tracheostoma transposition for dissociation of the cranial end of the trachea and the hypopharynx and esophagus is essential for effective closure. In rare cases of TPF combined with pharyngoesophageal stricture formation a resection and immediate reconstruction of the stenotic pharyngoesophageal segment with a tube-shaped fasciocutaneous radial forearm flap must be considered.

Keywords

Voice prosthesis Tracheostoma transposition Pharyngoesophageal reconstruction Pipe bowl plasty Tube-shaped radial forearm flap 
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Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  1. 1.Klinik für Hals-, Nasen- und OhrenheilkundeUniversitätsklinikum Schleswig-Holstein, Campus LübeckLübeckDeutschland

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