摘要
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。
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,intra operative blood transfusion,operative duration.With all varible 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 T 3、T 4 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.
出处
《临床耳鼻咽喉科杂志》
CSCD
北大核心
2001年第3期106-109,共4页
Journal of Clinical Otorhinolaryngology
关键词
喉肿瘤
全喉切除术
咽瘘
病因
Laryngeal neoplasms
Total laryngectomy
Pharyngo cutaneous fistula
