喉癌术后继发颈部出血的临床危险因素分析

目的探讨喉癌术后继发颈部出血的临床危险因素。方法选择2009年2月至2012年3月收治的喉癌患者150例，所有患者都采用环状软骨上喉部分切除术，对并发症与随访预后生存情况进行调查分析。结果所有患者均得到随访，生存率为96．7％。发生并发症15例，其中有5例为继发颈部出血。单因素分析显示，肿瘤部位、肿瘤T分期、颈淋巴结转移、先期气管切开、颈部淋巴结清扫术和术前术后放射治疗能影响喉癌术后继发颈部出血（P〈0．05）。多因素分析显示，肿瘤部位、肿瘤T分期与颈淋巴结转移为主要的独立危险因素（P〈0．05）。结论环状软骨上喉部分切除术应用于喉癌治疗能取得比较好的效果，但是容易导致术后继发颈部出血，多与患者的肿瘤部位、肿瘤T分期与颈淋巴结转移有关，为此要在手术前对患者进行合理评估。

The clinical risk factors analysis for cervical bleeding after laryngectomy

Objective To study the clinical risk factors for cervical bleeding after laryngectomy. Methods 150 patients with laryngeal cancer treated in our hospital from February 2009 to March 2012 were given cricoid partial laryngeetomy, the complications and survival prognosis were followed up and analyzed. Results All patients were followed up, the survival rate was 96. 7%. 15 complications cases occurred, which included 5 cases of secondary cervical bleeding. Univariate analysis showed that the tumor site,T stage,lymph node metastasis, pre-tracheotomy, cervical lymph node dissection and preoperative and postoperative radiotherapy can affect laryngeal carcinoma secondary cervical bleeding （ P 〈 0.05 ）. Multivariate analysis showed that tumor site,tumor T stage and cervical lymph node metastasis were the major independent risk factors （P 〈0. 05 ）. Conclusions Cricoid partial laryngectomy achieved better results in laryngeal cancer treatment, but likely leaded to postoperative secondary neck bleeding resulted from the tumor site,tumor T stage and cervical lymph node metastasis. Reasonable assessment before surgery was necessary.