喉癌下咽癌术后并发咽瘘的个体化治疗方法探讨

目的 探讨喉癌、下咽癌术后并发咽瘘的个体化治疗方法.方法 回顾分析2008年1月-2013年6月喉癌、下咽癌术后并发咽瘘48例患者的临床特点及处理方法.48例术后病理诊断均为鳞状细胞癌,其中小咽瘘（直径≤1 cm）28例、中咽瘘（直径1～2 cm）12例、大咽瘘（直径≥2 cm）8例,邻近气管或喉的咽瘘40例,合并基础疾病者42例;31例行清创、换药治疗,3例行局部滑行皮瓣修复、2例行局部桥型皮瓣修复、12例行胸大肌皮瓣修复.结果 48例患者咽瘘均成功修复.12例胸大肌皮瓣修复的病例中,有2例胸大肌皮瓣部分坏死、1例大部分坏死,皆不影响咽瘘的成功修复.结论 喉癌、下咽癌术后并发咽瘘患者因咽瘘部位、大小及患者全身情况不同而临床特点各异,针对不同情况采用个体化综合治疗措施可有效治疗咽瘘.

Individualized treatment for the pharyngocutaneous fistula after surgery of laryngeal and hypopharyngeal cancer

Objective To investigate the individualized treatment for the pharyngocutaneous fistula after surgery of laryngeal and hypopharyngeal cancer.Methods From January 2008 to June 2013,48 cases of pharyngocutaneous fistula after surgery of laryngeal and hypopharyngeal cancer with different clinical characteristics and therapeutic measures were retrospectively analyzed.They were all pathologically confirmed squamous cell carcinoma,of which 28 cases of small pharyngocutaneous fistula （diameter ≤ 1 cm）,12 cases of medium pharyngocutaneous fistula（diameter 1-2 cm） and 8 cases of large ones （diameter≥2 cm）.There were 40 cases of pharyngocutaneous fistula adjacent to the trachea or larynx,and 42 cases associated with underlying diseases.Among 48 cases of different pharyngocutaneous fistula,debridement and dressing change were performed in 31 cases; the sliding flap repair in 3 cases,the bridge flap in 2 cases and the pectoralis major flap in 12 cases.Results Forty-eight cases of different pharyngocutaneous fistula were all repaired successfully.Twelve cases were repaired through the pectoralis major flap.Of which 2 cases came out partial necrosis and 1 case was necrotic mostly,but neither affected the success of pharyngocutaneous fistula repair.Conclusions Each pharyngocutaneous fistula after surgery of laryngeal and hypopharyngeal carcinoma has different clinical features because of its different location,size and the patient＇s general condition.According to different conditions,using individualized comprehensive treatment measures can effectively treat pharyngocutaneous fistula.