全喉切除术后并发咽瘘的相关因素分析与防治

Related factors and precautions of pharyngeal fistula following laryngectomy

对78例全喉切除术病例临床资料进行回顾性分析,其中并发咽瘘29例,发生率37.2％;同时提示,手术技巧是咽瘘发生的关键因素,其次丝线间断缝合、血浆(半)管引流、缩短手术时间等有助于减少咽瘘的形成,而病变范围、术前放疗和术前气管切开等则可能促进咽瘘的发生,术前、术后Hb、切口类型对咽瘘形成影响不大。故应针对上述相关因素做好咽瘘的防治工作,减少咽瘘的发生。

A retrospective review was made of 78 cases of laryngectomy. It was found that pha-ryngeal fistula complicated by surgery in 29 cases,the incidence of fistulization was 37. 2% , meanwhile the measures to decrease it were discussed. The results indicated that the key factor might be the surgical technique and also showed a significant association of the increased risk of fistulization with the tumor stage as well as preoperative tracheotomy or irradiation. On the other hand,interrupted sutures, half-tube drainage, restricted operative time significantly decreased the risk. There was no correlation between preoperative or postoperative hemoglobin levels or the selection of inci. sions and the incidence of fistula.