喉癌及下咽癌手术后咽瘘的治疗及预防

目的探讨喉癌、下咽癌手术后并发咽瘘的治疗和预防措施。方法喉癌手术后并发咽瘘5例，其中2例行胸大肌皮瓣修补术；下咽癌手术后并发咽瘘11例，其中2例行咽瘘缝合术。结果喉癌术后咽瘘5例，3例经换药愈合，2例巨大咽瘘，其中l例行胸术肌皮瓣修补术，未愈合又行咽瘘缝合愈合，另1例第1次胸大肌皮瓣修补后失败，安装硅橡胶管后恢复正常饮食，6个月后行二次胸大肌皮瓣修补愈合。下咽癌术后咽瘘11例，经换药2～4周愈合9例，另2例经换药4周，局部炎症已控制，瘘口缩小为1～2cm，行咽瘘缝合术愈合。结论喉癌、下咽癌术后并发咽瘘，是该手术的严重并发症之一。多数经换愈，少数病例必须行咽瘘修补术。应在手术前、手术中及手术后采取一些必要措施预防咽瘘。

Management and prevention of pharyngeal fistula after surgery for larynx and lower pharynx cancer

Objective To discuss the management and prevention of pharyngeal fistula after surgery for larynx and lower pharynx cancer. Methods 5 patients had pharyngeal fistula after laryngectomy and 2 were treated by surgery. 11 patients had pharyngeal fistula after lower pharynx cancer resection and 2 were treated by surgery. Results Among the 5 patients with pharyngeal fistula after laryngectomy ,3 were cured by dressing change and 2 by pectoralis major myocuta- neous flap neoplasty. Among the 11 patients with pharyngeal fistula after lower pharynx cancer resection,9 were cured by dressing change after 2 to 4 weeks and 2 were treated by dressing change for 4 weeks and then were cured by suture. Conclusion Pharyngeal fistula after surgery of larynx and lower pharynx cancer is one of the serious complications. Most patients can be cured by dressing change and some must be treated by surgery. It is necessary to take some measurements before, during and after operation.