喉部分切除术后肺部并发症的影响因素分析

Analysis on factors affecting postoperative pulmonary complications after partial laryngectomy

目的分析1998至2010年间111例喉部分切除术与术后肺部并发症相关的危险因素。：与法回顾性病例分析，评估喉部分切除术术后肺部并发症的发生与其影响因子的相关程度，影响因子包括年龄，性别，慢性肺疾病，吸烟状态，肿瘤大小，肿瘤分期，术前放疗，手术范围，手术重建方法，肺功能检查。结果36例患者（32．4％）发生肺部并发症，与年龄（P=0．002）、慢性肺疾病（P=0．005）、吸烟状态（P=0．02）有显著相关性；手术方式中环状软骨舌骨吻合术（P=0．008），同侧杓状软骨切除术（P=0．03），亦有相关性。多变量分析显示肺部并发症与年龄（60—69岁之间比值比[0R]为3．8，95％置信区间[CI]为1．2～11．7；70。79岁之间OR为7．1；95％CI为1．3～37．6）和环状软骨舌骨吻合术术式（OR，4．4；95％CI，1．1～18．1）具有显着相关性。结论60岁以上年龄和环状软骨舌骨吻合术术式是环状软骨上喉部分切除术后发生肺部并发症的高毹因素。

Objective To determine the risk factors related to postoperative pulmonary complications in patients who underwent partial laryngectomy. Methods Retrospective analysis of medical records was carried out. 111 patients who underwent partial laryngectomy from March 1, 1998 to October31, 2010 were studied and analyzed. Relationship between postoperative pulmonary complications and perioperative risk factors, such as age, sex, chronic lung disease, smoking status, tumor site, tumor stage, preoperative irradiation, extent of surgery, reconstruction method, and pulmonary function tests were all observed and evaluated. Results 36 patients （32.4%） were found to have postoperative pulmonary complications. ：Significant correlations were found among age （_P = 0.002）, chronic lung disease （P = 0.005）, smoking status （P = 0.02）, and also the postoperative pulmonary complications. Cricohyoidopexy （P= 0.008） and ipsilateral arytenoidectomy （P= 0.03） were associated with postoperative pulmonary complications. The multivariate analysis showed a significant association of the postoperative pulmonary complications with age （odds ratio[OR], 3.8; 95% confidence interval [CI], 1.2-11.7 in patients who were 60 to 69 years old; and OR, 7.1;95% CI, 1.3-37.6 in patients 70 to 79 years old） and cricohyoidopexy （OR, 4.4; 95% CI, 1.1-18.1）. Conclusion Patients＇ over 60 years of age and patients with cricohyoidopexy are the high risk factors of having postoperative pulmonary complications after supracricoid partial laryngectomy.