全喉切除术后气管感染对喉癌患者肺功能及肿瘤复发率的影响

Influence of tracheal infection after total laryngectomy on pulmonary function and tumor recurrence rate in patients with laryngocarcinoma

目的探讨全喉切除术后气管感染对喉癌患者肺功能及复发情况的影响。方法选取喉癌患者276例,其中行喉癌全喉切除术者149例,全喉切除术＋颈部淋巴结清扫者127例,观察患者术后感染情况、肺功能及复发情况。结果术后发生感染26例（9.42%）,喉癌全切术感染发生率为4.03%（6/149）,全切＋淋巴结清扫感染率为15.75%（20/127）,二者比较,差异具有统计学意义（P〈0.05）。手术时间〈4 h的患者感染率为2.11%（3/142）,低于4~6 h的11.76%（11/102）及〉6 h的37.50%（12/32）,且4~6 h的感染率低于〉6 h的感染率,差异均具有统计学意义（P〈0.01）;与术前比较,术后气管感染组患者FEV1%明显升高,V25明显降低;感染患者肿瘤复发率为34.62%明显高于未感染患者的2.00%（P〈0.01）。结论喉癌患者全喉切除术后肺功能有一定变化,且存在一定的感染复发风险,应采取措施尽可能降低感染发生,改善预后。

Objective To explore the influence of tracheal infection after total laryngectomy on pulmonary function and tumor recurrence rate in patients with laryngocarcinoma. Methods A total of 276 patients with laryngocarcinoma were selected,in which 149 received total laryngectomy,and 127 received total laryngectomy plus neck lymph node dissection. Postoperative infection,pulmonary function and recurrence conditions of all patients were observed. Results Totally 26（ 9. 42%） patients had postoperative infection,in which the infection rate of patients with total laryngectomy was 4. 03%（ 6 /149） whereas that of patients with total laryngectomy plus neck lymph node dissection was 15. 75%（ 20 /127）,and there was significant difference（ P〈0. 05）. The infection rate was 2. 11%（ 3 /142） in patients with surgical duration 4 h,11. 76%（ 11 /102） in patients with surgical duration 4-6 h and 37. 50%（ 12 /32） in patients with surgical duration 6 h,and the rate of patients with surgical duration 4-6 h was markedly lower than that 6 h（ P〈0. 01）. Compared with surgery before,forced expiratory volume in 1 second（ FEV1） increased obviously while V25 reduced markedly in patients in postoperative tracheal infection group. The tumor recurrence rate was 34. 62% in patients with tracheal infection, significantly higher than the 2. 00% in those with non-infection（ P〈0. 01）.Conclusion Patients with laryngocarcinoma have certain improvement in pulmonary function and risk of infection and recurrence after total laryngectomy,so effective measurements should be conducted to reduce the infection rate and promote patients＇ prognosis.