Saki Nader, Nikakhlagh Soheila, Kazemi Maryam
Department of Otolaryngology, Head and Neck Surgery, Ahwaz Jondishapour University of Medical Sciences, Ahwaz, Iran.
Arch Iran Med. 2008 May;11(3):314-7.
Pharyngocutaneous fistula is a common and troublesome postoperative complication after total laryngectomy. The objective of this report was to determine the incidence, predisposing factors, and outcome of postlaryngectomy pharyngocutaneous fistula in patients operated on in our department and to describe the management of the complication.The medical records of 146 consecutive patients who underwent laryngeal surgery for squamous cell carcinoma of the larynx between 1990 and 2005 were assessed. All patients had similar preoperative/postoperative care. We studied a number of factors that could influence fistula formation such as age, gender, smoking, systemic disease, preoperative radiotherapy, previous tracheotomy, site of tumor, surgical procedure, positive surgical margins, type of closure (T vs. vertical), concurrent neck dissection, suture material, clinical stage, histologic grade, and experience of surgeon (consultant vs. resident). A pharyngocutaneous fistula was observed in 13% (19/146) of the patients within a mean time of 9.6 days from surgery. Spontaneous closure with local wound care was noted in 17 (89%) patients whereas a surgical closure was necessary in two. One patient required surgical closure by direct suture of the pharyngeal mucosa. Pectoralis major myocutaneous flap was used in another one. Our findings showed that fistula formation was significantly more common in patients who received previous radiotherapy or who had positive surgical resection margins or had a systemic disease. The mean healing time was 26 days. We concluded that pharyngocutaneous fistula remains a troublesome complication of the early postoperative period after total laryngectomy. There are many conflicting reports in the literature concerning the predisposing factors, but our data showed that the presence of systemic diseases, previous radiotherapy, and positive surgical margins can all be important predisposing factors, or at least underlying causes. Our experience confirmed that most fistulas can be successfully managed with conservative treatment.
咽皮肤瘘是全喉切除术后常见且棘手的术后并发症。本报告的目的是确定在我科接受手术的患者中喉切除术后咽皮肤瘘的发生率、易感因素及结局，并描述该并发症的处理方法。评估了1990年至2005年间146例因喉鳞状细胞癌接受喉部手术的连续患者的病历。所有患者术前/术后护理相似。我们研究了许多可能影响瘘管形成的因素，如年龄、性别、吸烟、全身性疾病、术前放疗、既往气管切开术、肿瘤部位、手术方式、手术切缘阳性、缝合类型（T形与垂直形）、同期颈部清扫术、缝合材料、临床分期、组织学分级以及外科医生的经验（顾问医生与住院医生）。13%（19/146）的患者在术后平均9.6天出现咽皮肤瘘。17例（89%）患者经局部伤口护理后自行愈合，2例患者需要手术修复。1例患者通过直接缝合咽黏膜进行手术修复。另1例患者使用了胸大肌肌皮瓣。我们的研究结果表明，既往接受过放疗、手术切缘阳性或患有全身性疾病的患者瘘管形成明显更常见。平均愈合时间为26天。我们得出结论，咽皮肤瘘仍然是全喉切除术后早期棘手的并发症。关于易感因素，文献中有许多相互矛盾的报道，但我们的数据表明，全身性疾病、既往放疗和手术切缘阳性均可能是重要的易感因素，或至少是潜在原因。我们的经验证实大多数瘘管可通过保守治疗成功处理。
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