Incidence and predisposing factors of pharyngocutaneous fistula formation after total laryngectomy. Is there a relationship with tumor recurrence?
Incidence and predisposing factors of pharyngocutaneous fistula formation after total laryngectomy. Is there a relationship with tumor recurrence?
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DOI：
10.1007/s00405-003-0643-6
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发表时间：
2004-02-01
影响因子：
2.6
通讯作者：
Daniilidis, IC
中科院分区：
文献类型：
--
作者：
Markou, KD;Vlachtsis, KC;Daniilidis, IC
咽瘘是全喉切除术后最常见的并发症（8.7%~ 22%）。该研究的目的是确定在我科接受手术的患者中喉切除术后瘘管的发生率，以确定特定因素是否容易导致瘘管形成，并确定瘘管和肿瘤复发是否相关。我科自1992年至2001年共收治喉癌377例，均行全喉切除术。在这些患者中，有291例全喉切除术作为其疾病的主要管理，而在86例手术治疗疾病复发。在92例患者中，全喉切除术联合根治性或折衷性颈淋巴结清扫术。在研究的377例患者中，有49例（13%）确定存在早期术后瘘。经统计学分析，癌分期、肿瘤的准确定位、分化程度、既往放疗、患者年龄、是否行颈清扫术或紧急气管切开术以及是否安装发音假体均对术后瘘的发生率无显著影响。具有统计学意义的因素是肿瘤手术切缘的组织学浸润（11%阴性vs 38%阳性切缘）和共存的早期并发症。在大多数病例中，瘘管管理是保守的。瘘管所需的闭合时间在5至81天之间（平均：29天）。所有患者的术后随访显示，瘘并不影响肿瘤复发的发生率。在我们的研究中，术后瘘的发生率为13%。肿瘤切除不完全和并发症并存，除其他外，瘘形成率较高。全喉切除术后肿瘤复发率与术后瘘管的存在无关。
Pharyngocutaneous fistula is the most common complication (8.7 to 22%) in the immediate postoperative period following total laryngectomy. The study's objective was to determine the incidence of post-laryngectomy fistulas in patients operated on in our department to establish whether specific factors predispose to fistula formation and to determine whether fistulas and tumor recurrence are related. Between 1992 and 2001, 377 cases of laryngeal carcinoma were diagnosed, and the patients underwent total laryngectomy in our department. Of these patients, 291 had total laryngectomy as the primary management of their disease, while in 86 patients the operation treated recurrence of the disease. In 92 patients, total laryngectomy was combined with radical or eclectic neck dissection. The presence of early postoperative fistula was established in 49 of the 377 patients (13%) studied. The cancerous stage, exact localization of the tumor, degree of differentiation, previous irradiation, patient's age, performance or not of neck dissection or emergency tracheostomy and fitting of voice prostheses were all factors that, after statistical analysis, did not appear to significantly influence the incidence of postoperative fistulas. Factors that did show statistical significance were the histological infiltration of the tumor's surgical margins (11% negative vs. 38% with positive margins) and coexisting early complications. Fistula management was conservative in the majority of cases. The necessary closure period for a fistula varied between 5 and 81 days (mean: 29 days). Postoperative follow-up of all patients revealed that fistulas did not influence the incidence of tumor recurrence. The incidence of postoperative fistulas in our study was 13%. Incomplete excision of the tumor and coexisting complications were related, among other things, to a higher rate of fistula formation. The rate of tumor recurrence after total laryngectomy was not related to the presence of a fistula during the postoperative period.