喉癌患者手术切除治疗后发生咽瘘的危险因素分析

Clinical intervention measures and risk factors of pharyngeal fistula in patients with laryngeal cancer after surgical resection treatment

目的 探讨喉癌患者手术切除治疗后发生咽瘘的危险因素,为制定临床干预措施提供依据。方法 回顾性选取郑州大学第一附属医院2020年1月至2022年12月收治的行手术切除治疗的喉癌患者218例。根据手术切除治疗后是否发生咽瘘分为咽瘘组和非咽瘘组,采用单因素和采用二元logistic回归分析喉癌患者手术切除治疗后发生咽瘘的危险因素。结果 218例喉癌患者手术切除治疗后咽瘘发生率为23.39%。单因素分析结果证实,咽瘘组与非咽瘘组合并糖尿病、肿瘤分期、术前营养状况、术前血红蛋白、术前气管切开、术前放疗、手术方式、手术时长、皮瓣修复、术后感染情况比较有统计学差异(P<0.05);二元logistic回归分析证实,合并糖尿病、术前营养状况差,术前血红蛋白<120 g/L、术前气管切开、术前放疗、喉全切术手术方式、手术时长≥4 h、皮瓣修复、术后感染是喉癌患者手术切除治疗后发生咽瘘的独立危险因素(P<0.05)。结论 根据上述结果中喉癌患者手术切除治疗后发生咽瘘的独立危险因素,临床上应采取合理的干预措施,减少咽瘘的发生,提升患者术后生存质量,改善喉癌患者的预后。

Objective To explore the risk factors of pharyngeal fistula in patients with laryngeal cancer after surgical re⁃section treatment,and to provide a basis for developing clinical intervention measures.Methods A retrospective selec⁃tion was conducted on 218 laryngeal cancer patients who underwent surgical resection treatment in our hospital from Jan⁃uary 2020 to December 2022.According to whether pharyngeal fistula occurred after surgical resection treatment,all pa⁃tients were divided into pharyngeal fistula group and non pharyngeal fistula group.Single factor and binary logistic re⁃gression analysis were used to analyze the risk factors of pharyngeal fistula in laryngeal cancer patients after surgical re⁃section treatment.Results The incidence of pharyngeal fistula was 23.39%in 218 patients with laryngeal cancer after surgical resection.The results of univariate analysis confirmed that there were significant differences in diabetes,tumor stage,preoperative nutritional status,preoperative hemoglobin,preoperative tracheotomy,preoperative radiotherapy,surgical methods,surgical duration,flap repair,and postoperative infection between the pharyngeal fistula group and the non pharyngeal fistula group(P<0.05);binary logistic regression analysis confirmed that diabetes,poor preoperative nutritional status,preoperative hemoglobin<120 g/L,preoperative tracheotomy,preoperative radiotherapy,total laryn⁃gectomy,operation duration≥4 hours,skin flap repair,postoperative infection were independent risk factors of pharyn⁃geal fistula in patients with laryngeal cancer after surgical resection treatment(P<0.05).Conclusion Based on the independent risk factors for pharyngeal fistula in laryngeal cancer patients after surgical resection treatment,reasonable intervention measures should be taken in clinical practice to reduce the occurrence of pharyngeal fistula,improve the postoperative quality of life of patients,and improve the prognosis of laryngeal cancer patients.