影响喉癌及下咽癌术后咽瘘的多因素分析  

Multivariate analysis of pharyngo cutaneou fistulas after larynx cancer and lower pharynx cancer surgery

作　　者：苏家坤 赵峰[1] 魏小林[1] 苏纪平[1] 

机构地区：[1]广西医科大学第一附属医院耳鼻咽喉头颈外科南宁530021 [2]北海市第二人民医院耳鼻咽喉科,北海536000

出　　处：《临床耳鼻咽喉头颈外科杂志》2015年第7期581-584,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨影响喉癌及下咽癌术后并发咽瘘的相关因素。方法:回顾分析87例采用手术治疗的喉癌及下咽癌患者的临床资料,根据术后有无咽瘘分为咽瘘组和无咽瘘组。将患者年龄、手术前后电解质、肿瘤分期、手术方式等38个相关因素进行多因素分析。差异性指标作二元回归分析。结果:87例喉癌及下咽癌手术患者中有11例(12.64%)术后发生咽瘘。单因素分析表明:术前体质指数、术前血钾、手术时间、同期颈清扫、术后前白蛋白、术后白蛋白、术后切口延迟愈合及切口感染是咽瘘发生的危险因素(P<0.05)。Logistic回归分析结果表明:术后前白蛋白、手术时间均是影响咽瘘发生的独立危险因素。结论:围手术期间应及时纠正患者电解质紊乱及负氮平衡,缩短手术时间,控制术后切口感染及延迟愈合等不良因素,可尽量避免术后咽瘘的发生。Objective：To investigate the relative factors of pharyngo cutaneou fistulas after larynx cancer and lower pharynx cancer surgery.Method：The clinical datas of 87 larynx cancer patients and lower pharynx cancer patients admitted were retrospectively analyzed.According to the type of postoperative complications all cases could be divided into pharyngo cutaneou fistulas group and no pharyngo cutaneou fistulas group.Thirty-eight kinds of factors,including age,clinical stage,plasma electrolytes level and type of procedure are in the multivariate analysis,and the variability indicators are in binary-regression analysis.Result：Eleven patients had pharyngo cutaneou fistulas（12.64%）.Univariate analysis indicated that BMI,pre-operative serum potassium,operation time,cervical lymph dissection,post-operative prealbumin,post-operative hemoglobin,infection and delayed union of incision were the risk factors of pharyngo cutaneou fistulas（P〈0.05）.Logistic stepwise regression analysis indicated that post-operative prealbumin and operation time were the independent risk factors.Conclusion：To avoid pharyngo cutaneou fistulam,it is very necessary to correct electrolyte disorder and negative nitrogen balance.To shorten the operation time,to avoid incision infection and delayed union were helpfulness,too.

关 键 词：喉肿瘤 下咽肿瘤 咽瘘 危险因素 

分 类 号：R739.65[医药卫生—肿瘤]