喉癌术后感染的相关因素分析

发布时间：2018-08-19 18:50

【摘要】：目的:分析喉癌术后感染的相关因素,探讨喉癌术后发生感染的主要原因,并针对其原因提出防治建议。方法:回顾性分析吉林大学白求恩第一医院2011年1月至2015年12月诊治的342例喉癌手术患者的临床资料,将无术后感染及术后颈深部感染(包括含咽瘘的颈深部感染和无咽瘘的颈深部感染)分2组,其中有54例发生术后颈深部感染(感染率为15.8%),包括咽瘘17例,采用SPSS22.0统计学软件进行分析,卡方检验统计出影响喉癌术后感染的因素,并从中选出明显影响术后感染的稳定性因素建立Logistic多因素回归分析模型,检验水准α=0.05并以表格的形式描述结果。结果:共收集资料342例,年龄36~60(不包括60)岁患者164例,≥60岁者178例,平均年龄(60.08±8.69)岁,其中术后感染54例(15.8%),咽瘘17例(5.0%)。术前放疗患者3例,其中感染2例(66.7%),咽瘘1例(33.3%);未放疗者339例,其中感染51例(15.0%),咽瘘16例(31.4%)。术前气管切开者29例,其中咽瘘5例(17.2%),未气切者313例,咽瘘12例(3.8%)。临床分期:0-Ⅱ期139例,其中感染12例,咽瘘2例(16.7%),Ⅲ期52例,其中感染8例,咽瘘2例(3.8%),Ⅳ期59例,其中感染17例,咽瘘7例(11.9%)。肿瘤分型,声门上型125例,其中感染30例,咽瘘10例(8.0%),声门型203例,其中感染17例,咽瘘3例(1.4%),贯声门型8例,其中感染者3例,咽瘘1例(12.5%),喉癌复发6例,感染3例,均为咽瘘(50%)。全喉切除者75例,其中感染22例,咽瘘12例(16.0%),喉部分切除术者156例,其中感染31例,咽瘘5例(3.2%)。术前有基础疾病(糖尿病)16例,其中感染5例,咽瘘2例(12.5%),无糖尿病326例,感染48例,咽瘘15例(4.6%)。单因素分析结果表明:临床分期、肿瘤分期、住院时长、术前气管切开、喉癌术式、同期颈部淋巴结清扫、留置引流管、安全缘、手术时长等9个单因素与术后感染的发生有统计学意义(P0.05)。在此基础上建立Logistic多因素回归分析模型,最终得出结果酗酒史、手术时间、肿瘤分期、手术方式是术后感染发生的独立影响因素。结论:喉癌术后常见颈深部感染,其导致感染的原因与酗酒史、手术时间、肿瘤分期、手术方式、术前气管切开有关。术前气管切开、手术时间、肿瘤分期及手术方式之间具有相关性,肿瘤分期高,肿瘤侵及范围广,手术复杂需要的手术时间长,术后发生感染的风险高,术前气管切开喉癌术后感染的风险增加;其次全喉切除术比部分喉切除术术后发生感染的风险高。影响喉癌术后感染的因素很多,我们的目的是针对合并高危因素喉癌患者,积极改善、解决、避免上诉相关的因素,尽量降低术后感染的发生。
[Abstract]:Objective: to analyze the related factors of postoperative infection of laryngeal carcinoma, to explore the main causes of postoperative infection of laryngeal carcinoma, and to put forward suggestions for prevention and treatment. Methods: the clinical data of 342 patients with laryngeal carcinoma treated in Bethune first Hospital of Jilin University from January 2011 to December 2015 were retrospectively analyzed. The patients were divided into two groups: no postoperative infection and deep cervical infection (including deep neck infection with pharyngeal fistula and deep neck infection without pharyngeal fistula). Among them, 54 cases had postoperative deep cervical infection (infection rate was 15.8%), including 17 cases of pharyngeal fistula. The factors influencing postoperative infection of laryngeal carcinoma were analyzed by SPSS22.0 software and chi-square test, and the stability factors of postoperative infection were selected to establish Logistic multivariate regression model. Test level 伪 0.05 and describe the results in tabular form. Results: 342 cases were collected, 164 cases were aged 36 ~ 60 (excluding 60), 178 cases were 鈮，

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