喉癌下咽癌术后咽瘘防治

发布时间：2018-04-25 19:29

  本文选题：咽瘘 + 喉癌　； 参考：《郑州大学》2011年硕士论文

【摘要】：目的 分析喉癌、下咽癌术后咽瘘的主要原因,根据分析结果提出相应预防措施。 方法 收集2009年1月1日到2011年1月1日期间,经郑州大学第一附属医院耳鼻喉科收治的198例喉癌下咽癌(包括187例喉癌和11例下咽癌)手术患者的完整病例资料,使用SPSS10.0软件进行统计学分析。 结果 187例喉癌患者术后18例(9.6%)发生咽瘘,11例下咽癌患者术后3例(27.3%)发生咽瘘。全组病例除1例梭形细胞软组织肉瘤外,其余197例均为喉(或下咽)鳞状细胞癌。统计学分析结果显示,咽瘘发生的主要影响因素有：是否合并糖尿病,有无术前放疗,喉切除术前是否行气管切开,肿瘤分期,手术方式,同期有无行颈淋巴结清扫以及术后48小时内体温是否持续高于37.5度。患者的年龄、性别,肿瘤生长部位及手术时间等与咽瘘的发生无统计学意义。资料表明合并糖尿病,术前接受放疗和气管切开,肿瘤Ⅲ期、Ⅳ期,行喉全切除和(或)下咽切除术,同期行颈淋巴结清扫,术后48小时内体温高于37.5度的患者术后并发咽瘘的几率明显大于无糖尿病,术前未行放疗和气管切开,肿瘤Ⅰ-Ⅱ期,行喉部分切除,未行颈淋巴结清扫术,术后体温无明显升高的患者。 结论 咽瘘发生的高危因素主要有以下几点：1、术前血红蛋白低于正常值；2、术前合并糖尿病；3、术前接受放疗；4、术前行气管切开；5、肿瘤Ⅲ期-Ⅳ期；6、行喉全切除(或包括下咽部分切除)术；7、同期行颈淋巴结清扫术；8、术后48小时内体温持续高于37.5度。 对于合并以上高危因素的喉癌、下咽癌患者,须于术前将其营养状况调整至最佳；术中严格把握手术适应症,尤其应规范颈淋巴结的处理,避免漏诊的同时应注意减少患者不必要的创伤；术后加强护理。如此才能最大限度的减少咽瘘发生,减轻患者的负担。
[Abstract]:Purpose The main causes of postoperative pharyngeal fistula in laryngeal carcinoma and hypopharyngeal carcinoma were analyzed and corresponding preventive measures were put forward. Method From January 1, 2009 to January 1, 2011, 198 patients with hypopharyngeal carcinoma (including 187 laryngeal cancer and 11 hypopharyngeal carcinoma) treated by the otolaryngology department of the first affiliated Hospital of Zhengzhou University were collected. SPSS10.0 software was used for statistical analysis. Result Pharyngeal fistula occurred in 18 patients with laryngeal carcinoma (n = 18) and pharyngeal fistula in 11 patients with hypopharyngeal carcinoma (n = 3). All the 197 cases were squamous cell carcinoma of larynx (or hypopharynx) except one spindle cell soft tissue sarcoma. The results of statistical analysis showed that the main factors influencing the occurrence of pharyngeal fistula were: diabetes mellitus, preoperative radiotherapy, tracheotomy before laryngectomy, tumor staging, operation methods, Neck lymph node dissection was performed at the same time and body temperature was higher than 37.5 degrees within 48 hours after operation. Age, sex, tumor site and operative time were not significantly associated with the occurrence of pharyngeal fistula. Data showed that with diabetes, preoperative radiotherapy and tracheotomy, stage 鈪，

本文编号：1802646