喉部分切除术后喉狭窄的相关因素分析

Analysis of relevant factors causing laryngeal stenosis after partial laryngectomy

目的探讨喉部分切除术后发生喉狭窄的影响因素。方法选择1994年1月—2004年10月在中山大学附属一院耳鼻咽喉科医院进行喉部分切除术138例患者为研究对象,就性别、年龄、病变分期、肿瘤原发部位、甲状软骨支架及喉内软组织切除范围、修复方式、术中是否放置喉模、术后使用抗生素时间、术后放疗、术后肺部感染、糖尿病和胃食管反流13个相关因素,用LOGISTIC回归进行多因素分析。结果138例患者中发生喉狭窄25例,发生率为18·1%。多因素分析结果表明,甲状软骨支架切除范围(Χ2=4·323,P=0·038)、术后放疗(Χ2=6·002,P=0·014)、术后肺部感染(Χ2=4·220,P=0·04)、胃食管反流(Χ2=5·614,P=0·018)与术后发生喉狭窄有关。结论喉部分切除术后发生喉狭窄的影响因素是多方面的。统计学研究表明,甲状软骨支架切除范围、术后放疗、术后肺部感染、胃食管反流是其危险因素。

Objective To investigate the clinical relevant factors causing laryngeal stenosis after partial laryngectomy. Methods A retrospective study was carried out to review the history clinical data from 138 patients of partical laryngectomy in the First Affliliated Hospital of Sun Yat-Sen University between January 1994 to October 2004 . The clinical relevant factors causing laryngeal stenosis were included as follows： age , sex , TNM stage, tumor site, extension of thyroid cartilage defect, extension of larynx parenchyma defect, reconstruction method, laryngeal dilator, duration of using antibiotics, postoperative radiotherapy, lung infection, gastroesophageal reflux, diabetes. Multivariate stepwise logistic regression model was used for the analysis. Results Of 138 cases after partial laryngectomy, stenosis developed in 25 cases. The occurrence rate was 18. 1%. In multivariate analysis, it was confirmed that the following factors correlated to laryngeal stenosis, i. e, extension of thyroid cartilage defect （ X^2 = 4. 323, P = 0. 038 ） , postoperative radiotherapy （ X^2 = 6. 002, P = 0. 014 ） , lung infection （ X^2 = 4. 220, P = 0. 040 ）, and gastroesophageal reflux （X^2 = 5. 614, P = 0. 018 ）. Conclusions The clinical relevant factors causing laryngeal stenosis after partial laryngectomy were multiple. Statistical analysis showed that extension of thyroid cartilage defect, postoperative radiotherapy, lung infection and gastroesophageal reflux were the risk factors which may cause laryngeal stenosis.