ORAL-FEEDING AFTER TOTAL LARYNGECTOMY
ORAL-FEEDING AFTER TOTAL LARYNGECTOMY
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DOI：
10.1002/hed.2880110314
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发表时间：
1989-05-01
影响因子：
2.9
通讯作者：
MEYERS, AD
中科院分区：
文献类型：
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作者：
BOYCE, SE;MEYERS, AD
全喉切除术后15%-25%的患者发生咽皮瘘。可能导致瘘管形成的因素包括既往放疗、手术技术、肿瘤大小和位置以及患者营养状况。此外，许多外科医生认为，手术后口服喂养的时间有助于瘘管的发展。因此，他们主张术后延迟进食，尤其是高危患者。传统的指导原则是等到术后第七天。本研究的目的是探讨鳞状细胞癌患者全喉切除一期缝合术后经口进食时间与咽瘘发生的关系。一份调查问卷被发送给210名美国头颈外科学会的成员，以确定喉切除术后喂养的实践模式。我们还回顾了1975年1月至1987年12月在科罗拉多大学健康科学中心和丹佛VA医学中心接受全喉切除术的137例患者的记录。在接受调查的外科医生中，84.5%的人在手术后至少等待7天才开始开始经口进食。然而，在回顾94例符合研究条件的患者时，我们发现术后第5天或之前进食的患者与术后第6天或之后进食的患者之间的瘘形成率没有差异。事实上，大多数瘘管在患者开始口服之前就很明显了。梨状窝肿瘤易发生瘘管，但既往放疗和颈淋巴结清扫术似乎无影响。全喉切除术后早期经口进食可提高病人的舒适度，缩短住院时间，而不增加并发症的发生率。梨状窝肿瘤或复杂闭合的患者更容易发生瘘管，因此延迟口服喂养可能有益。
Pharyngocutaneous fistulae occur in 15%‐25% of patients after total laryngectomy. Factors that may predispose to fistulae formation include prior radiation, surgical technique, tumor size and location, and patient nutritional status. In addition, many surgeons believe that the timing of oral feeding after surgery contributes to fistula development. Thus, they advocate delaying feeding postoperatively, especially in high‐risk patients. The traditional guidline has been to wait until the seventh postoperative day. The purpose of this study was to examine the relationship between the timing of postoperative oral feeding and the development of pharyngocytaneous fistulae after total laryngectomy with primary closure in patients with squamous cell carcinoma. A questionnaire was sent to 210 members of the American Society for Head and neck Surgery to determine practice patterns toward feeding after laryngectomy. We also reviewed the records of 137 patients who underwent total laryngectomy at the University of Colorado Health Sciences Center and the Denver VA Medical Center from January 1975 through December 1987. Of the surgeons polled, 84.5% waited at least 7 days after surgery to begin oral feeding. However, in reviewing 94 patients eligible for study, we found no difference in the rate of fistula formation between patients fed on or before the fifth postoperative day and those fed on or after the sixth postoperative day. In fact, most fistulae were evident before the patient started oral feeding. Pyriform sinus tumors were predisposed to fistulae but prior radiotherapy and neck dissection seemed to have no effect. Earlier oral feeding after total laryngectomy may improve patient comfort and shorten hospital stay without increasing the incidence of complications. Patients with pyriform sinus tumors or complicated closures are more likely to develop fistulae and therefore may benefit from delayed oral feeding.