晚期喉咽癌和喉癌全喉切除术后咽皮肤瘘

目的:探讨晚期喉咽癌和喉癌患者施行全喉切除术后咽皮肤瘘的位置、易患因素、处置及其结果.方法:回顾性分析因喉咽癌或喉癌施行全喉切除术的198例患者的资料,分析多因素对咽皮肤瘘形成的影响.结果:发生咽皮肤瘘患者33例(16.7%),内瘘口位于黏膜吻合口上段23例(69.7%),下段7例(21.2%),中段3例(9.1%);喉咽癌与喉癌的咽皮肤瘘发生率分别为24.7%和11.6%,其差异具有统计学意义(P<0.05);术后持续发热>5 d与≤5 d者咽皮肤瘘的发生率差异具有统计学意义(P<0.01);28例通过保守治疗痊愈,5例手术修复.结论:全喉切除术后咽皮肤瘘内瘘口多发生于舌根处和气管造瘘后上方,肿瘤部位和术后发热是咽皮肤瘘形成的重要易患因素.     

喉癌全喉切除术后咽瘘的原因分析

目的探讨喉癌患者行全喉切除术后发生咽瘘的原因,以预防或降低咽瘘的发生率,提高喉癌术后切口的愈合率.方法回顾分析141例喉癌患者行全喉切除术后发生咽瘘的原因.结果141例患者咽瘘发生率为27.66%,与手术时间,拔除胃管时间,术前有无合并感染,以及抗生素的应用有关.结论喉癌术后发生咽瘘的原因有多重性,避免相关因素,能有效降低咽瘘的发生率,提高患者术后生存质量.     

全喉切除术后咽瘘——一个一直未解决的问题

文章对56例全喉切除术病人进行总结，了解术后咽瘘发生情况。全部病例均由同一位医生施行手术。咽瘘发生率为12．5％。文章提出无特殊原因与咽瘘发生有关。一旦发生咽瘘无需二次手术，经口给予固体食物，经鼻饲管给予液体，可使咽瘘愈合。     

喉全切除术后咽瘘的预防

咽瘘是喉全切除术后的早期并发症。多年来人们一直在寻找有效的预防措施,努力降低其发生率。我们总结以前咽瘘发生的原因,采取了一些预防措施,使我院喉全切除术后咽瘘的发生率明显下降。现将我院１９９１～１９９５年因喉癌行喉全切除术２１８例患者术后发生咽瘘的情况进行回顾性分析,旨在探讨咽瘘发生的相关因素和预防措施。１　资料与方法２１８例中,男１４６例,女７２例;年龄３４～８０（平均５８．７）岁,按１９８７年ＵＩＣＣ标准Ⅱ期３４例,Ⅲ期９４例,Ⅳ期９０例。术前放疗者５例。１６８例同期行颈廓清术,其中单侧１０７…     

全喉切除术并发咽瘘的相关因素分析

对行全喉切除术160例中并发咽瘘的37例进行分析,认为咽瘘的发生与病变范围、手术方式与技巧、术后感染、气管切开、放疗以及术后处理等因素相关,并据以提出减少咽瘘的措施。     

喉切除术后咽瘘的预防和治疗

目的 本文讨论了减少喉切除术后咽瘘发生的外科技巧和围手术期处理。方法 共对365例经由喉全切除术和喉大部分切除术治疗的喉恶性肿瘤病例的临床资料进行分析,其中喉全切除术333例,喉大部分切除术32例。结果 365例喉切除术后28例发生咽瘘,发生率为7.7％;其中喉全切除术后27例发生咽瘘,发生率8.1%;喉大部分切除发音管重建术后1例发生咽瘘,发生率3.1％。结论 采用喉咽食管黏膜分层缝合方式,以及术后颈部持续负压引流对于降低咽瘘发生率关系密切。喉大部分切除发音管重建术的咽瘘发生率低于喉全切除术,可能与喉大部分切除保留一侧梨状窝黏膜,喉咽黏膜缺损较小有关。     

中西医结合治疗全喉切除术后并发咽瘘的临床观察

咽瘘是全喉切除术后最常见的早期严重并发症之一。我院自1991年1月至1997年12月共发生9例咽瘘,采用中西医结合进行治疗,获得满意效果。现将治疗体会报告如下。1临床资料与方法1．1一般资料9例咽疾病人全部为男性,年龄最小32岁,最大76岁,平均58岁。病理报告为鳞癌！～五级,临床分型按UICCTNM方案（1987）为TaNOM～T川。M,术式采用全喉切除术或同时行颈廓清术。住院天数最短45天,最长187天,平均6S天。9例病人咽疾处分泌物培养：绿脓杆菌4例,大肠杆菌2例,变形杆菌2例,l例培养阴性。1．2治疗方法所有咽疾病人均采用鼻腔留置胃…     

全喉切除术后咽瘘发生的多因素分析

目的：探讨全喉切除术后咽瘘的早期诊断和治疗。方法：对1993-2001年间的86例全喉切除术的临床资料进行回顾性分析。结果：术后72h内平均体温超过38.5℃组中，病人的咽瘘发生率为60％，肿瘤的临床分期、术中肌皮瓣的应用、术前放疗的剂量与咽瘘的发生有密切关系，咽瘘一般通过保守治疗可愈合。结论：术后早期高热可有助于警示咽瘘的发生，手术中粘膜缝合主张“无张“、“严密“，应用肌皮瓣时注意保护血供，术前预防性放射治疗剂量以不超过40Gy为宜。高度怀疑咽瘘者尽早开放创口。     

预防喉切除术后咽瘘的体会

咽瘘是喉切除术后早期较重且发生率较高的并发症之一,多年来人们一直在探索寻找有效的预防措施,努力降低其发生率。现就本院1990年来诊治的各类喉切除术共145例,有关咽瘘并发症的发生体会总结报道如下。     

Pharyngocutaneous fistula following total laryngectomy

Pharyngocutaneous fistula (PCF) is the most common complication after total laryngectomy.ObjectivesTo establish the incidence of this complication and to analyze the predisposing factors.MethodThis is a cross-sectional study of a historical cohort including 94 patients who underwent total laryngectomy. The following aspects were correlated to the occurrence of PCF: gender, age, tumor site, TNM staging, type of neck dissection, previous radiation therapy, previous tracheotomy, and use of stapler for pharyngeal closure. The following were considered in PCF cases: the day into postoperative care when the fistula was diagnosed, duration of occurrence, and proposed treatment.ResultsTwenty (21.3%) patients had PCF. The incidence of PCF was statistically higher in T4 tumors when compared to T2 and T3 neoplasms (p = 0.03). The other analyzed correlations were not statistically significant. However, 40.9% of the patients submitted to tracheostomy previously had fistulae, against 21.1% of the patients not submitted to this procedure.ConclusionAdvanced primary tumor staging is correlated with higher incidences of PCF.     

Early oral feeding following total laryngectomy

OBJECTIVES: The time to begin oral feeding after total laryngectomy remains a subject of debate among head and neck surgeons. The prevailing assumption is that early initiation of oral feeding may cause pharyngocutaneous fistula; thus, the common practice of initiating oral feeding after a period of 7 to 10 days. The objective of the study was to demonstrate the feasibility and safety of oral feeding 48 hours after total laryngectomy. STUDY DESIGN: Two-part study includes, first, a sequential study and, second, a prospective analysis of our practice. METHODS: Patients undergoing total laryngectomy without partial pharyngectomy or radiation treatment (except irradiation through small ports for a T1 or T2 glottic carcinoma) were included. In the first, sequential part of the study (part I), a group of 18 patients who were fed 7 to 10 days after total laryngectomy (control group) was compared with a group of 20 patients who received oral feeding within 48 hours. To confirm the results of part I, a prospective analysis of this practice was conducted (part II) in which 35 additional patients who met the above criteria were fed within 48 hours after surgery. RESULTS: In part I, pharyngocutaneous fistula occurred in one patient (5%) in the early feeding group and in two patients (11%) in the control group. In part II, pharyngocutaneous fistula occurred in one patient (2.8%). Overall, fistula occurred in two patients in the combined early feeding group (3.6%). This rate of pharyngocutaneous fistula compares favorably with the fistula rate in the control group of 18 patients. Pharyngeal stricture that required dilation occurred in three of our patients in the study group and two in the control group (5.5% vs. 11%, respectively). The length of hospital stay was significantly shortened from 12 to 7 days. CONCLUSION: Our results indicate that in this patient population initiation of oral feeding 48 hours after total laryngectomy is a safe clinical practice.     

全喉切除术后咽瘘的原因分析与防治措施

目的探讨全喉切除术后咽瘘发生的易感因素、治疗方法及预防措施。方法收集2000年1月～2011年12月行全喉切除术患者114例。对可能影响咽瘘发生的一系列因素包括年龄、术前放疗、颈廓清术范围、肿瘤位置和肿瘤临床分期等进行了回顾性研究。结果术后12例患者发生咽瘘(10.5%),7例咽瘘患者的愈合需要外科治疗干预,其中6例通过咽部黏膜组织的直接缝合而达到治愈,1例行胸大肌皮瓣移植术;另5例通过局部换药、加压包扎等保守方法,瘘口治愈闭合。所有患者均随访2个月以上。结论文献中关于咽瘘发生的相关因素虽存有很多的争议,但研究表明血红蛋白水平,是否有糖尿病,肿瘤位置,肿瘤TNM分级及临床分期与咽瘘发生密切相关。大部分患者的咽瘘通过保守换药治疗,必要时局部直接清创缝合的方法可以达到治愈的效果。     

Pharyngocutaneous fistula following total laryngectomy and post-operative vomiting

The significance of post-operative vomiting as a risk factor in the development of a pharyngocutaneous fistula was examined. The case records of 50 consecutive patients undergoing laryngectomies (39 men, 11 women, average age 64 years) were examined. 17 also underwent a simulataneous radical neck dissection. A fistula developed in eight patients (16%) and the median time to its diagnosis was 11 days (range 3–15 days). Several potential risk factors were examined including age, gender, previous radiotherapy. TNM stage, differentiation of tumour, simultaneous radical neck dissection and also the occurrence of vomiting post-operatively. In this series of patients only vomiting in the early post-operative period appeared to be related to the development of a fistula (regression summary: R2 = 0.6, t-value 5.6. P < 0.0001). An episode of vomiting was recorded in eight patients and of these six (75%) subsequently developed a fistula. The median time of post-operative vomiting was 7.5 days (range 1–10 days) and the diagnosis of a fistula occurred at a mean of 1.2 ± 0.4 days after the episode of vomiting. In a study of this nature it is not possible to conclude that a causal relationship exists between vomiting. In a study of this nature it is not possible to conclude that a causal relationship exists between vomiting and fistula development. However, if this is the case a pottential means of decreasing the incidence of fistulae following laryngectomy may be available.     

选择性咽缩肌切断术在全喉切除术后发音重建中的作用

对１０例喉癌患者行全喉切除术后Ⅱ期Ｂｌｏｍ－Ｓｉｎｇｅｒ发音重建，并行选择在咽缩肌切断术，术后８例发音重建成功，并对咽缩肌切断术的作用及要点加以讨论。     

Pharyngocutaneous fistula after salvage laryngectomy

Conclusion: Preoperative chemoradiotherapy (CRT) was associated with a significantly higher rate of pharyngocutaneous fistula (PCF). Objective: PCF is the most frequent complication following total laryngectomy. Although organ-preserving radiotherapy (RT) or CRT offer good locoregional control, many patients still require salvage laryngectomy. The aim of this study was to evaluate the factors that predispose patients to PCF, with a focus on preoperative RT, induction chemotherapy (ICT), and CRT. Methods: This was a retrospective case series; 151 patients who underwent TL were reviewed. Preoperative RT, ICT, CRT, and some surgical parameters were analyzed as potential risk factors. Results: The overall PCF rate was 13%. CRT was the only preoperative treatment that had a significant effect on PCF (35.3%, p = 0.004, odds ratio (OR) = 10.75). Surgery extended to the pharynx (p = 0.005, OR = 8.34) and vacuum drain duration (p = 0.012, OR = 5.16) were observed to be associated with PCF.     

直线吻合器在全喉切除术中的应用

目的探讨一次性直线型吻合器在喉癌手术中的应用效果。方法选取我科2019年10例全喉切除手术患者,采用随机分组方法,分为封闭法和半封闭法两组。总结比较所用手术时间、术中出血量、术后咽瘘感染的发生率。结果所有手术都顺利完成,会厌软骨残留1例,咽瘘1例。结论直线吻合器在全喉切除术中具有较好的临床应用价值。