直线闭合器在喉癌全喉切除术中应用的临床分析

Analysis of clinical application of linear stapler in total laryngectomy

目的评价直线闭合器在喉癌全喉切除术中的应用价值,比较分析闭合器使用与手工缝合的优缺点。方法收集2012年10月1日-2016年1月1日中国医学科学院肿瘤医院诊治的喉鳞状细胞癌患者71例,按回顾性非随机对照研究法分为两组,其中闭合器组20例,手工缝合组51例。分析比较两组临床参数,包括手术时间、是否发生咽瘘、手术其他并发症,以及咽瘘与术前气切、术前放疗、切口选择的关系。结果闭合器组出现咽瘘3例（15%）,手工缝合组出现咽瘘8例（16%）。两组11例咽瘘患者皮肤切口均采用T型切口,各项临床参数差异均无统计学意义（P〉0.05）。结论喉癌全喉切除术中采用直线闭合器与采用手工缝合两组咽瘘发生率无明显差异,临床中可根据患者具体情况进行选择。

Objective To evaluate the value of applying linear stapler in total laryngectomy,and compare the pros and cons between linear stapler and manual suture. Methods 71 cases of laryngeal squamous cell carcinoma were collected during Oct 1st,2012 to Jan 1st,2016. They were divided into two groups. Linear stapler group had 20 cases.The other 51 cases with manual suture in total laryngectomy were chosen as the control group. Clinical parameters such as surgery time,negative margin proportion,pharyngeal fistula proportion,and other post-operative complications were compared and analyzed. The relationships among pharyngeal fistula with preoperative tracheostomy, preoperative radiotherapy and incision type were discussed. Results Pharyngeal fistula occurred in 11 cases,including 3 in linear stapler group（ 15%） and 8 in the control group（ 16%）. The incision type of all pharyngeal fistula cases was T-shaped.The differences of above-mentioned parameters between the two groups were all statistically insignificant（ all P〉 0. 05）.Conclusion Linear stapler is a selectable apparatus for suturing technology in total laryngectomy.