晚期喉咽癌和喉癌全喉切除术后咽皮肤瘘

目的:探讨晚期喉咽癌和喉癌患者施行全喉切除术后咽皮肤瘘的位置、易患因素、处置及其结果.方法:回顾性分析因喉咽癌或喉癌施行全喉切除术的198例患者的资料,分析多因素对咽皮肤瘘形成的影响.结果:发生咽皮肤瘘患者33例(16.7%),内瘘口位于黏膜吻合口上段23例(69.7%),下段7例(21.2%),中段3例(9.1%);喉咽癌与喉癌的咽皮肤瘘发生率分别为24.7%和11.6%,其差异具有统计学意义(P<0.05);术后持续发热>5 d与≤5 d者咽皮肤瘘的发生率差异具有统计学意义(P<0.01);28例通过保守治疗痊愈,5例手术修复.结论:全喉切除术后咽皮肤瘘内瘘口多发生于舌根处和气管造瘘后上方,肿瘤部位和术后发热是咽皮肤瘘形成的重要易患因素.

Pharyngocutaneous fistula following total laryngectomy in patients with advanced stage hypopharyngeal or laryngeal carcinomas

Objective:To investigate the locations,predisposing factors,managements and outcomes of pharyngocutaneous fistula(PCF) following total laryngectomy in patients with advanced stage hypopharyngeal or laryngeal carcinomas.Method:One hundred and ninty-eight patients with advanced hypopharyngeal or laryngeal carcinomas who were performed by total laryngectomy were analyzed retrospectively.The multiple predisposing factors,including age,sex,preoperative radiotherapy,previous tracheostomy,stage,differentiation,site,neck dissection and postoperative fever,were analyzed.Result:The incidence of PCF was 16.7%.The situations of orificium fistulae lied in 69.7% superior segment,21.2% inferior and 9.1% middle segment respectively.The incidence of PCF was 24.7% in hypopharynx and 11.6% in larynx respectively.There were significant differences between them.The differences of postoperative continuous fever beyond 5 days were statistical significance between the group of PCF and no PCF.In them,28 patients of PCF were healed spontaneously and 5 of them were healed by surgical operation.Conclusion:PCF is often situated in tongue base and post-superior of trachea stoma.Tumor locations and postoperative fever are important predisposition.