下咽癌术后咽瘘发生的相关危险因素分析(1)
[摘要]目的 探讨下咽癌术后咽瘘发生的相关危险因素。方法 选取我院2006年5月～2015年12月接诊的43例下咽癌患者作为研究对象，对患者的T分期、N分期、术前放疗、术前气切、喉功能保留与否、局部有无感染、手术时间、皮瓣修复与否等因素与患者在术后咽瘘发生的关系进行Logistic分析和单因素分析。结果 43例下咽癌患者中，有9例患者术后发生咽瘘，发生率为20.93%。单因素分析结果显示，术前放疗、术前气切、喉功能切除、发生局部感染、手术时间较长和进行皮瓣修复的患者在术后出现咽瘘的概率显著高于术前未放疗、术前未气切、喉功能保留、未发生局部感染、手术时间较短和未进行皮瓣修复的患者(P=0.0276、0.0096、0.0276、0.0296、0.0073、0.0113)；T1+T2分期的患者出现咽瘘的概率显著低于T3+T4分期的患者(P=0.0096)；N0+N1分期的患者出现咽瘘的概率与N2+N3分期的患者差异无统计学意义(P=0.3826)。Logistic分析结果显示，下咽癌患者在术后发生咽瘘的独立危险因素是素肿瘤T分期(OR=5.376，P=0.047)和局部感染(OR=16.651，P=0.002)。结论 临床上在保证治疗效果的前提下，术前准备、手中及术后护理，可预防相关危险因素的发生，同时还需做好相应处理危险因素的措施，进一步降低下咽癌患者术后咽瘘发生的概率。
[关键词]下咽癌；咽瘘；术后感染；相关因素
[中图分类号]R739.63 [文献标识码]A [文章编号]1674-4721(2016)06(b)-0090-03
Related risk factor analysis on incidence of pharyngeal fistula after hypopharyngeal carcinoma operation
LAI Zhuo-kai ZHAO Yun-feng XIE Yi
Department of Otolaryngology Head and Neck Surgery，Zhanjiang Central People′s Hospital，Zhanjiang 524037，China
[Abstract]Objective To discuss the related risk factors of pharyngeal fistula after hypopharyngeal carcinoma operation.Methods 43 patients with hypopharyngeal carcinoma treated in our hospital from May 2006 to December 2015 were selected.The related factors of pharyngeal fistula after operation including T stage，N stage，preoperative radiotherapy，preoperative tracheotomy，laryngeal function preservation，time duration of operation，flap repairing，and local infection were analyzed by Logistic analysis and single factor analysis.Results Pharyngeal fistula was observed in 9 patients of the 43 patients，and the incidence rate was 20.93%.The result of single factor analysis showed that the incidence of pharyngeal fistula was significantly higher in patients with preoperative radiotherapy，preoperative tracheotomy，laryngeal function resection，local infection，longer operation time，and flap repairing (P=0.0276，0.0096，0.0276，0.0296，0.0073，0.0113)；the incidence rate was significantly lower in patients at T1+T2 stages than in those at T3+T4 stages (P=0.0096)；and there was no significant difference between patients at N0+N1 stages and patients at N2+N3 stages (P=0.3826).The result of Logistic analysis showed that T stage (OR=5.376，P=0.047) and local infection (OR=16.651，P=0.002) were independent risk factors of pharyngeal fistula after operation.Conclusion Based on assurance of therapeutic effect，risk factors should be prevented in preoperative preparation，operation process，and postoperative care.Measures should also be taken to manage risk factors and to further reduce the incidence of pharyngeal fistula after hypopharyngeal carcinoma operation. (赖卓凯 赵云峰 谢怡)
[关键词]下咽癌；咽瘘；术后感染；相关因素
[中图分类号]R739.63 [文献标识码]A [文章编号]1674-4721(2016)06(b)-0090-03
Related risk factor analysis on incidence of pharyngeal fistula after hypopharyngeal carcinoma operation
LAI Zhuo-kai ZHAO Yun-feng XIE Yi
Department of Otolaryngology Head and Neck Surgery，Zhanjiang Central People′s Hospital，Zhanjiang 524037，China
[Abstract]Objective To discuss the related risk factors of pharyngeal fistula after hypopharyngeal carcinoma operation.Methods 43 patients with hypopharyngeal carcinoma treated in our hospital from May 2006 to December 2015 were selected.The related factors of pharyngeal fistula after operation including T stage，N stage，preoperative radiotherapy，preoperative tracheotomy，laryngeal function preservation，time duration of operation，flap repairing，and local infection were analyzed by Logistic analysis and single factor analysis.Results Pharyngeal fistula was observed in 9 patients of the 43 patients，and the incidence rate was 20.93%.The result of single factor analysis showed that the incidence of pharyngeal fistula was significantly higher in patients with preoperative radiotherapy，preoperative tracheotomy，laryngeal function resection，local infection，longer operation time，and flap repairing (P=0.0276，0.0096，0.0276，0.0296，0.0073，0.0113)；the incidence rate was significantly lower in patients at T1+T2 stages than in those at T3+T4 stages (P=0.0096)；and there was no significant difference between patients at N0+N1 stages and patients at N2+N3 stages (P=0.3826).The result of Logistic analysis showed that T stage (OR=5.376，P=0.047) and local infection (OR=16.651，P=0.002) were independent risk factors of pharyngeal fistula after operation.Conclusion Based on assurance of therapeutic effect，risk factors should be prevented in preoperative preparation，operation process，and postoperative care.Measures should also be taken to manage risk factors and to further reduce the incidence of pharyngeal fistula after hypopharyngeal carcinoma operation. (赖卓凯 赵云峰 谢怡)