【作者】 李韬；

【导师】 娄卫华；

【作者基本信息】 郑州大学 ， 耳鼻咽喉头颈外科， 2011， 硕士

【摘要】 目的分析喉癌、下咽癌术后咽瘘的主要原因,根据分析结果提出相应预防措施。方法收集2009年1月1日到2011年1月1日期间,经郑州大学第一附属医院耳鼻喉科收治的198例喉癌下咽癌(包括187例喉癌和11例下咽癌)手术患者的完整病例资料,使用SPSS10.0软件进行统计学分析。结果187例喉癌患者术后18例(9.6%)发生咽瘘,11例下咽癌患者术后3例(27.3%)发生咽瘘。全组病例除1例梭形细胞软组织肉瘤外,其余197例均为喉(或下咽)鳞状细胞癌。统计学分析结果显示,咽瘘发生的主要影响因素有：是否合并糖尿病,有无术前放疗,喉切除术前是否行气管切开,肿瘤分期,手术方式,同期有无行颈淋巴结清扫以及术后48小时内体温是否持续高于37.5度。患者的年龄、性别,肿瘤生长部位及手术时间等与咽瘘的发生无统计学意义。资料表明合并糖尿病,术前接受放疗和气管切开,肿瘤Ⅲ期、Ⅳ期,行喉全切除和(或)下咽切除术,同期行颈淋巴结清扫,术后48小时内体温高于37.5度的患者术后并发咽瘘的几率明显大于无糖尿病,术前未行放疗和气管切开,肿瘤Ⅰ-Ⅱ期,行喉部分切除,未行颈淋巴结清扫术,术后体温无明显升高的患者。结论咽瘘发生的高危因素主要有以下几点：1、术前血红蛋白低于正常值；2、术前合并糖尿病；3、术前接受放疗；4、术前行气管切开；5、肿瘤Ⅲ期-Ⅳ期；6、行喉全切除(或包括下咽部分切除)术；7、同期行颈淋巴结清扫术；8、术后48小时内体温持续高于37.5度。对于合并以上高危因素的喉癌、下咽癌患者,须于术前将其营养状况调整至最佳；术中严格把握手术适应症,尤其应规范颈淋巴结的处理,避免漏诊的同时应注意减少患者不必要的创伤；术后加强护理。如此才能最大限度的减少咽瘘发生,减轻患者的负担。更多还原

【Abstract】 Purpose:To explore the etiology, mechanism and prevention measures through analysis of the main cause of Pharyngo-cutaneous fistula after surgery of laryngeal carcinoma and hypopharyngeal carcinoma.Methods:Collecting complete medical records of 198 patients with laryngeal carcinoma and hypopharyngeal carcinoma (including 187 cases of laryngeal carcinoma and 11 of hypopharyngeal carcinoma) from 2009 to 2011 at Department of Otolaryngology, first Affiliated Hospital of Zhengzhou University and analyzing statistically by using of SPSS10.0.Results:Among the 187 cases of laryngeal carcinoma,18 cases (9.6%) were Pharyngo-cutaneous fistula after operation and 3 in 11 cases (27.3%) of hypopharyngeal carcinoma. Except of the only 1 cases of spindle cells of soft tissue sarcomas, the rest of 197 are larynx (or swallow) squamous cell carcinoma. According to the statistical analysis results, the predominant influencing factors in the causation of Pharyngo-cutaneous fistula are tumor stage and operation method. Meanwhile, whether patients have merger diabetes, preoperative radiation, lower hemoglobin level, tracheotomy and lymph node dissection before survey as well as the temperature is over 37.5 degrees after survey do affect the results. It doesn’t have any statistical significance about the patient’s age, gender, tumor growth parts and operation time. Data shows that patients who have lower hemoglobin level, merger diabetes, preoperative radiation, tracheotomy and lymph node dissection before survey and got temperature over 37.5 degrees after survey risk greater complication than those without the treatment.Conclusion:High-risk factors for Pharyngo-cutaneous fistula following main points:1, lower preoperative hemoglobin level; 2, revealed diabetes mellitus; 3, Previous radiotherapy; 4, prior tracheotomy; 5, tumor stageⅢ～Ⅳ; 6, total laryngectomy 7, lymph node dissection; 8, temperature over 37.5 degrees within 48h.For these patients, we must determine preoperative nutritional status will be adjusted to the best of them; strictly control surgical indications; postoperative intensive care. Only in this way, it is possible reduce the occurrence of Pharyngo-cutaneous fistula, reduce the burden on patients.更多还原