全喉切除术后咽瘘的原因分析与防治措施

目的探讨全喉切除术后咽瘘发生的易感因素、治疗方法及预防措施。方法收集2000年1月～2011年12月行全喉切除术患者114例。对可能影响咽瘘发生的一系列因素包括年龄、术前放疗、颈廓清术范围、肿瘤位置和肿瘤临床分期等进行了回顾性研究。结果术后12例患者发生咽瘘(10.5%),7例咽瘘患者的愈合需要外科治疗干预,其中6例通过咽部黏膜组织的直接缝合而达到治愈,1例行胸大肌皮瓣移植术;另5例通过局部换药、加压包扎等保守方法,瘘口治愈闭合。所有患者均随访2个月以上。结论文献中关于咽瘘发生的相关因素虽存有很多的争议,但研究表明血红蛋白水平,是否有糖尿病,肿瘤位置,肿瘤TNM分级及临床分期与咽瘘发生密切相关。大部分患者的咽瘘通过保守换药治疗,必要时局部直接清创缝合的方法可以达到治愈的效果。

Causes, preventive and therapeutical measures of pharyngeal fistula after total laryngectomy

Objective To explore the predisposing factors, the preventive and therapeutical measures of pharyngeal fistula after total laryngectomy. Methods The medical records of 114 patients who underwent total laryngectomy from 2000 and 2011 were assessed. Factors which might influence pharyngeal fistula formation such as patients＇ age, preoperative radiotherapy, neck dissection, site of tumor and TNM stage were studied retrospectively. Results Of all 114 patients, 12 got pharyngeal fistula （ 10.5 % ）. The fistulas needed to be surgically dosed in 7 cases, including direct suture of the pharyngeal mucosa in 6 and closure with pectoralis major myocutaneous flap in another one. Spontaneous closure with local wound care was achieved in 5. Conclusion As for the pharyngeal fistula after total laryngectomy, there are many conflicting reports in literature concerning the predisposing factors. Our data shows that hemoglobin value, diabetes mellitus, tumor site, T and N grades and TNM stage of tumor are important predisposing factors. Most fistulas can be successfully managed with conservative treatment or direct surgical closure.