全喉切除术后咽瘘病因探讨

目的 :探讨全喉切除手术后咽瘘发生的原因。方法 :对 1983～ 1998年间行全喉切除手术的 12 5例患者的临床资料进行回顾性分析 ,并应用 SAS软件进行单因素和多因素统计处理。结果 :12 5例患者中有 2 0例(16 % )发生术后咽瘘 ,单因素分析表明 ,临床 T分期、肿瘤类型、放疗剂量、手术中输血及手术时间等 5个因素与咽瘘发生有关 ;L ogistic模型全因素分析显示 ,临床 T分期和放疗剂量与咽瘘发生有关 ,但术前放疗也可能是一个导致咽瘘的因素 (P =0 .0 5 6 6 ) ;L ogistic模型逐步回归分析显示 ,临床 T分期和手术时间是导致咽瘘的相关因素。结论 :临床 T分期、手术时间这两个因素与咽瘘的发生密切相关 ,术前放疗剂量和是否术前放疗也是影响咽瘘发生的相关因素。对于晚期肿瘤 ,术前经过放疗且放疗剂量较大的患者 ,术前应估计到发生咽瘘的可能 ;术中仔细缝合 ,提高手术的熟练程度 ,缩短手术时间 ,可减少咽瘘的发生。

Study of pharyngo-cutaneous fistula after total laryngectomy

OBJECTIVE: To explore the factors which lead to pharyngo-cutaneous fistula after total laryngectomy. METHOD: A retrospective study of 125 patients who underwent total laryngectomy during a 16-year period was carried out. RESULT: The rate of post-laryngectomy pharyngo-cutaneous fistula is 16.0% (20/125), it appears reduced tendency. With single-factor analysis, the factors effect on the rate of post-laryngectomy pharyngo-cutaneous fistula include clinical tumor stage, tumor types, pre-operative radiotherapy dose, intraoperative blood transfusion, operative duration. With all variable logistic model analysis, the factors effect on the rate of pharyngo-cutaneous fistula are clinical tumor stage and pre-operative radiotherapy dose, but pre-operative radiotherapy is very possible to be a risk factor (P = 0.0566). With logistic model stepwise regression analysis, the factors effect on the rate of pharyngo-cutaneous fistula are clinical tumor stage and operative duration. CONCLUSION: Pharyngo-cutaneous fistula appears easily in patients with T3, T4 tumor, and have pre-operative radiotherapy, especially have large dose preradiotherapy. For these high risk patients, the duration of operation should be as short as possible to reduce the rate of post-laryngectomy pharyngo-cutaneous fistula.