Stomal recurrence--etiologic factors and prevention.
Stomal recurrence--etiologic factors and prevention.
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造口复发——病因及预防。
DOI：
10.1016/s0385-8146(85)80007-9
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发表时间：
1985
期刊：
影响因子：
--
通讯作者：
M. Kinishi
中科院分区：
文献类型：
--
作者：
M. Amatsu;K. Makino;M. Kinishi
从1969年到1982年，在科比大学医院耳鼻喉科进行的总共340例喉切除术中，有20例吻合口复发。在术前气管造口术组中，52例患者中有6例（11.5%）发生造口复发，而手术气管造口术组中288例患者中有14例（4.9%）发生造口复发。在这20例吻合口复发中，7例为声门上型伴1例声门下型，9例为声门型伴8例声门下型，4例为原发性声门下癌。从喉切除术到吻合口复发的平均时间为16个月，从喉切除术后20天到55个月不等。还使用了文献中的报告。气管造口处肿瘤细胞接种和持续性气管前及气管旁淋巴结损害是最可能的两个主要病因。根据上述评价，我们提出以下预防措施：1）切除喉后彻底冲洗伤口，2）术前气管造口患者完全切除气管造口道，3）声门下病变的气管前和旁淋巴清扫，4）在上述情况下，喉切除术后应进行造口周围放射治疗。
Out of a total of 340 laryngectomies performed in the Department of Otorhinolaryngology at Kobe University Hospital from 1969 to 1982, there were 20 stomal recurrences. In the preoperative tracheostomy group, 6 out of 52 patients (11.5%) developed stomal recurrence compared to 14 out of 288 (4.9%) in the operative tracheostomy group. Of these 20 stomal recurrences, 7 were supraglottic with 1 subglottic extension, 9 were glottic with 8 subglottic extensions, and 4 were primary subglottic cancers. The mean interval between the laryngectomy and stomal recurrence was 16 months and ranged from 20 days to 55 months after laryngectomy.We analyzed our series together with recent material which had been subjected to pretracheal and paratracheal lymphatic dissection. Reports from the literature were also used. Tumor cell inoculation in the tracheostomy wound and persistent pretracheal and paratracheal lymph node lesion are the two most likely major etiologic factors. The above evaluation leads us to propose the following preventive measures 1) thorough irrigation of the wound following the removal of the larynx, 2) complete excision of the tracheostomy tract for preoperatively tracheostomized patients, 3) pretracheal and paratracheal lymphatic dissection for subglottic lesion, 4) in the above cases, laryngectomy should be followed by peristomal radiotherapy.