Vilaseca-González Isabel, Bernal-Sprekelsen Manuel, Blanch-Alejandro José-Luis, Moragas-Lluis Miguel
Department of Otorhinolaryngology, Hospital Clínic i Universitari de Barcelona, C/Villarroel 170, Barcelona 08036, Spain.
Head Neck. 2003 May;25(5):382-8. doi: 10.1002/hed.10207.
Because of the increase in indications for laser surgery to treat malignant tumors of the larynx and hypopharynx, a higher number of complications may be expected. We prospectively evaluated the frequency and characteristics of intraoperative and postoperative complications of early and advanced tumors of the larynx and hypopharynx treated with CO(2) laser surgery and the potential influence of the surgical learning curve on the complication rate.
Two hundred seventy-five patients operated in a tertiary referral center. Complications were classified either as major, requiring intensive medical treatment, blood transfusion, surgery, or ICU admission, or minor, resolving spontaneously or with conventional ambulatory treatment without sequelae. The surgical learning curve was analyzed by dividing the patients into two groups according to the date of surgery and then comparing the number of complications.
Complications occurred in 18.9% of patients; 9.8% were considered major and 9.1% minor. Complications included local infection (0.7%), emphysema (1%), cutaneous fistula (0.3%), postoperative bleeding (8%), airway ignition (0.3%), dyspnea (because of edema or stenosis) (1.8%), and swallowing difficulties or aspiration pneumonia (6.1%). The complication rate correlated significantly with tumor extension (p <.0001), the presence of diabetes mellitus (p =.01), and less surgical experience (p <.0001). Complications with severe sequelae occurred in two patients (p =.7).
Complications after transoral laser surgery of larynx and hypopharynx carcinomas are relatively frequent (18.9%), but serious sequelae and mortality rate are low. Complications are associated with tumor extension, limited surgical experience, and diabetes mellitus.
由于激光手术治疗喉和下咽恶性肿瘤的适应证增加，预计会出现更多并发症。我们前瞻性评估了采用二氧化碳激光手术治疗的早期和晚期喉及下咽肿瘤术中及术后并发症的发生率和特点，以及手术学习曲线对并发症发生率的潜在影响。
在一家三级转诊中心对275例患者进行手术。并发症分为严重并发症，即需要强化医疗治疗、输血、手术或入住重症监护病房；以及轻微并发症，即自行缓解或经常规门诊治疗无后遗症。根据手术日期将患者分为两组来分析手术学习曲线，然后比较并发症的数量。
18.9%的患者发生并发症；9.8%为严重并发症，9.1%为轻微并发症。并发症包括局部感染（0.7%）、气肿（1%）、皮肤瘘（0.3%）、术后出血（8%）、气道着火（0.3%）、呼吸困难（由于水肿或狭窄）（1.8%）以及吞咽困难或吸入性肺炎（6.1%）。并发症发生率与肿瘤范围（p <.0001）、糖尿病的存在（p =.01）以及手术经验较少（p <.0001）显著相关。两名患者出现了伴有严重后遗症的并发症（p =.7）。
喉和下咽癌经口激光手术后并发症相对常见（18.9%），但严重后遗症和死亡率较低。并发症与肿瘤范围、手术经验有限以及糖尿病有关。
