Markou Konstantinos D, Vlachtsis Konstantinos C, Nikolaou Angelos C, Petridis Dimitrios G, Kouloulas Athanasios I, Daniilidis Ioannis C
Department of Otorhinolaryngology and Head and Neck Surgery, AHEPA Hospital, Aristotle University of Thessaloniki, 54006 Thessaloniki, Greece.
Eur Arch Otorhinolaryngol. 2004 Feb;261(2):61-7. doi: 10.1007/s00405-003-0643-6. Epub 2003 Jul 10.
Pharyngocutaneous fistula is the most common complication (8.7 to 22%) in the immediate postoperative period following total laryngectomy. The study's objective was to determine the incidence of post-laryngectomy fistulas in patients operated on in our department to establish whether specific factors predispose to fistula formation and to determine whether fistulas and tumor recurrence are related. Between 1992 and 2001, 377 cases of laryngeal carcinoma were diagnosed, and the patients underwent total laryngectomy in our department. Of these patients, 291 had total laryngectomy as the primary management of their disease, while in 86 patients the operation treated recurrence of the disease. In 92 patients, total laryngectomy was combined with radical or eclectic neck dissection. The presence of early postoperative fistula was established in 49 of the 377 patients (13%) studied. The cancerous stage, exact localization of the tumor, degree of differentiation, previous irradiation, patient's age, performance or not of neck dissection or emergency tracheostomy and fitting of voice prostheses were all factors that, after statistical analysis, did not appear to significantly influence the incidence of postoperative fistulas. Factors that did show statistical significance were the histological infiltration of the tumor's surgical margins (11% negative vs. 38% with positive margins) and coexisting early complications. Fistula management was conservative in the majority of cases. The necessary closure period for a fistula varied between 5 and 81 days (mean: 29 days). Postoperative follow-up of all patients revealed that fistulas did not influence the incidence of tumor recurrence. The incidence of postoperative fistulas in our study was 13%. Incomplete excision of the tumor and coexisting complications were related, among other things, to a higher rate of fistula formation. The rate of tumor recurrence after total laryngectomy was not related to the presence of a fistula during the postoperative period.
咽皮肤瘘是全喉切除术后近期最常见的并发症（发生率为8.7%至22%）。本研究的目的是确定在我科接受手术的患者中喉切除术后瘘的发生率，以明确是否存在导致瘘形成的特定因素，并确定瘘与肿瘤复发是否相关。1992年至2001年期间，共诊断出377例喉癌患者，这些患者在我科接受了全喉切除术。其中，291例患者将全喉切除术作为其疾病的主要治疗方法，而86例患者的手术用于治疗疾病复发。92例患者的全喉切除术联合了根治性或选择性颈清扫术。在377例接受研究的患者中，有49例（13%）术后早期出现了瘘。经统计分析，癌肿分期、肿瘤确切位置、分化程度、既往放疗史、患者年龄、是否进行颈清扫术或紧急气管切开术以及是否安装语音假体等因素，似乎均未对术后瘘的发生率产生显著影响。具有统计学意义的因素是肿瘤手术切缘的组织学浸润情况（切缘阴性者为11%，阳性者为38%）以及并存的早期并发症。大多数情况下，瘘的处理是保守的。瘘的必要闭合时间为5至81天（平均29天）。对所有患者的术后随访显示，瘘并未影响肿瘤复发的发生率。我们研究中术后瘘的发生率为13%。肿瘤切除不完全以及并存并发症等因素，与较高的瘘形成率相关。全喉切除术后肿瘤复发率与术后期间是否存在瘘无关。
