全喉切除术后并发咽瘘的相关因素分析

Analysis of the Relative Factors of pharyngeal Fistula after Total Laryngectomy

目的探讨全喉切除术后并发咽瘘的相关因素。材料与方法对1991年1月～1997年12月间72例喉癌的全喉切除术进行回顾性分析，就并发咽瘘与术后感染、喉咽腔缝合技术、术前气管切开、术前放疗、病变范围与术式、手术历时、术腔引流及鼻饲时间等相关因素进行统计分析，数据采用卡方检验。结果术前气管切开17例，7例发生咽瘘，术前无气管切开的55例中12例发生咽瘘，咽瘘率分别为41．1％和21．8％（P＜0．05）。术前放疗5例，2例发生咽瘘，67例术前无放疗的患者17例发生咽瘘，咽瘘率分别为40％和25．4％（P＜0．01）。鼻饲时间＜10天的18例中13例发生咽瘘，10～15天的49例中4例发生咽瘘，＞15天的5例中2例发生咽瘘，咽瘘率分别为72．2％、8．2％和40.0％（P＜0．01）。术后感染22例中18例发生咽瘘，术后无感染50例仅1例发生咽瘘，咽瘘率分别为81．8％和2．0％（P＜0．01）。结论术后感染、术前气管切开、术前放疗及鼻饲时间的长短是造成咽瘘的主要原因。

Objective To study the relative factors of pharyngeal fistula after toal laryngectomy. Methods This report reviewed 72 cases of cancer of the larynx after total laryngectomy from January 1991 to December 1997. We have statistically analysed the pharyngeal fistula with infection after operation, the suture technigue of larypharyngeal cavity , the tracheotomy before operation, the radiotherapy before operation, the range of disease , the way of operation, the operation time, the cavity drainage and nasal feeding time. The chi-square test was adopted in the data, Rusults In 7 of 17 cases with tracheotomy before operation pharyngeal fistula occured. In 12 of 55 cases without tracheotomy before operation pharyngeal fistula occured. Phsryngeal fistula rate were 41. l% and 21 .8% respectively (p < 0.01) .In 2 of 5 cases with radiotherapy before operation Pharyngeal fistula occured and in 17 of 67 cases without radiotherapy before operation pharyngeal fistula occured. Pharyngeal fistula rates were 40% and 25.4% respectively (P < 0.01) .In 13 of 18 cases with nasal feeding time < 10 days pharyngeal fistula occured in 4 of 49 cases with nasal feeding time of 10 -15 dsys pharyngeal fistula occured, in 2 of 5 cases with nasal feeding time > 15 days pharyngeal fistula occured. Pharyngeal fistula rates were 72.2%,8.2% and 40% respectivly (P <0.01). In 18 of 22 cases with infection after operation pharyngeal fistula occured, In 1 of 50 cases without infection after operation pharyngeal fistula occured, pharyngeal fistula rates were 81. 8% and 2.0% respectively (P<0.01 ).Conclusions Infection after operation, tracheotomy before operation, radiotherapy before operation and nasal feeding time were the main reasons of causing pharyngeal fistula