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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。
Objective: To investigate the location, risk factors, management and outcome of pharyngeal fistula after total laryngectomy in patients with advanced laryngeal and laryngeal cancer. Methods: The data of 198 patients undergoing total laryngectomy for laryngopharyngeal carcinoma or laryngeal carcinoma were retrospectively analyzed. The effects of multiple factors on the formation of pharyngeal fistula were analyzed. Results: 33 patients (16.7%) had pharyngeal fistula, 23 (69.7%) had upper fistula, 7 (21.2%) had lower fistula, and 3 (9.1%) had middle fistula. The incidence of pharyngeal skin fistula was 24.7% and 11.6%, respectively, with statistical significance (P <0.05). The incidence of pharyngoesophageal fistula after 5 days and 5 days of follow-up was statistically significant (P <0.01). 28 cases were cured by conservative treatment and 5 cases were surgically repaired. Conclusion: Total laryngectomy fistula pharyngeal skin fistula occurred at the base of the tongue and tracheal fistula above the tumor site and postoperative fever is an important risk factor for the formation of pharyngeal skin fistula.