喉癌、下咽癌术后咽瘘危险因素的Meta分析

发布时间：2018-03-04 20:12

  本文选题：喉肿瘤　切入点：癌　出处：《山西医科大学》2011年硕士论文　论文类型：学位论文

【摘要】：目的系统评价喉、下咽恶性肿瘤喉全切除术后咽瘘发生的危险因素,以进一步明确咽瘘发生的影响因素,有效预防该并发症。方法以下咽、喉恶性肿瘤、喉全切除术和并发症或因素或原因或病因,以及咽瘘、皮肤瘘等为主题词全面检索MEDLINE、EMBASE数据库和中国生物医学文献数据库、中国学术期刊全文数据库和重庆维普数据库,按纳入及排除标准纳入参考文献,提取数据,采用RevMan4.2软件对纳入文献的数据进行汇总分析(meta-analysis,Meta分析)。结果共纳入26个临床病例研究,病例总数4091,咽瘘发生例数684。。全部入选病例咽瘘总发生率为16.72%。Meta分析结果显T3T4期患者咽瘘发生率高于T1T2期患者(OR 0.49,P0.0001)。气切患者咽瘘发生率高于无气切患者(OR 1.73,P=0.02)。术前接受放疗患者咽瘘发生率高于未接受放疗的患者(OR 3.39,P0.00001),声门上(OR 2.49,P=0.0003)及跨声门型(OR 2.50,P=0.03)喉癌患者咽瘘发生率高于声门型患者。同期行颈淋巴结清扫患者咽瘘发生率高于未行颈清患者(OR1.58,P=0.002)。手术时间＞4小时者咽瘘发生率高于≤4小时患者(OR 2.95,P0.00001)。术后血红蛋白≤120g／L时咽瘘发生率高于血红蛋白＞120g／L(OR 2.03,P=0.0004)。合并全身疾病者咽瘘发生率高于未合并全身疾病患者(OR 6.56,P=0.0001)。结论病变部位、晚期肿瘤(T3、T4)、术前气管切开、术前放疗、合并颈淋巴结清扫、术后血红蛋白小于120g／L、手术时间超过4小时及合并全身疾病是喉癌、下咽癌术后咽瘘发生的危险因素。
[Abstract]:Objective to evaluate the risk factors of pharyngeal fistula after total laryngectomy for laryngeal and hypopharyngeal malignant tumors, so as to further clarify the influencing factors of pharyngeal fistula and effectively prevent the complication. MEDLINE EMBASE database, Chinese biomedical literature database, full text database of Chinese academic journals and Chongqing Weipu database were searched for total laryngectomy and complications or factors or causes or causes, as well as pharyngeal fistula and skin fistula. According to the criteria of inclusion and exclusion, the data were extracted, and the data were collected and analyzed by RevMan4.2 software. The results were analyzed by meta-analysis and meta-analysis. The results were included in 26 clinical case studies. The total number of cases was 4091, and the total incidence of pharyngeal fistula was 684.The total incidence of pharyngeal fistula was 16.72.Meta-analysis showed that the incidence of pharyngeal fistula in patients with stage T3T4 was higher than that in patients with stage T1T2. The incidence of pharyngeal fistula in patients with pneumotomy was higher than that in patients without pneumectomy. The incidence of pharyngeal fistula in patients with radiotherapy was higher than that in patients without radiotherapy (OR 3.39, P 0.00001, OR 2.49, P = 0.0003) and transglottic type, OR 2.50 / P0. 03)) the incidence of pharyngeal fistula in patients with laryngeal carcinoma was higher than that in patients with glottic type, and the incidence of pharyngeal fistula in patients with neck lymph node dissection was higher than that in patients without neck dissection at the same time. The incidence of pharyngeal fistula in patients with operation time > 4 hours was higher than that in patients with less than 4 hours. The incidence of pharyngeal fistula in patients with postoperative hemoglobin 鈮，

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