晚期喉咽癌和喉癌全喉切除术后咽皮肤瘘

Pharyngocutaneous fistula following total laryngectomy in patients with advanced stage hypopharyngeal or laryngeal carcinomas

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 locations, predisposing factors, managements and outcomes of pharyngocutaneous fistula （PCF） following total laryngectomy in patients with advanced stage hypopharyngeal or laryngeal carcinomas. Method： One hundred and ninty-eight patients with advanced hypopharyngeal or laryngeal carcinomas who were performed by total laryngectomy were analyzed retrospectively. The multiple predisposing factors, including age, sex, preoperative radiotherapy, previous tracheostomy, stage, differentiation, site, neck dissection and postoperative fever, were analyzed. Result：The incidence of PCF was 16.7 %. The situations of orificium fistulae lied in 69.7% superior segment, 21.2% inferior and 9.1 % middle segment respectively. The incidence of PCF was 24.7% in hypopharynx and 11.6% in larynx respectively. There were significant differences between them. The differences of postoperative continuous fever beyond 5 days were statistical significance between the group of PCF and no PCF. In them, 28 patients of PCF were healed spontaneously and 5 of them were healed by surgical operation. Conclusion：PCF is often situated in tongue base and post-superior of trachea stoma. Tumor locations and postoperative fever are important predisposition.