ENT, Head and Neck Surgery Department, University Hospital Rangueil-Larrey, 24 Chemin de Pouvourville TSA 30030, 31059, Toulouse Cedex 9, France.
Eur Arch Otorhinolaryngol. 2010 Sep;267(9):1415-21. doi: 10.1007/s00405-010-1238-7. Epub 2010 Jun 26.
The objective of the study was to analyze the incidence, treatment, and prevention of early and late respiratory complications in a series of patients who had supracricoid partial laryngectomies with either cricohyoidoepiglottopexy or cricohyoidopexy. From medical charts, we retrospectively reviewed 101 patients who underwent supracricoid partial laryngectomies, from 1980 to 2006, for laryngeal squamous cell carcinoma, and recorded the various postoperative complications and the time of decannulation. The mortality rate was 3.96%. Early complications included broncho-pulmonary infections and laryngeal stenoses which occurred in 9.9%. Univariate analysis showed a statistically significant relationship between the pulmonary complications and neck dissections (p < 0.04). Later, they were due to laryngeal obstruction (neolaryngeal mucosal flap, residual false vocal cord fold or arytenoid edema). The median decannulation time was 8 days, and there was a significant relationship between the decannulation delay and the pulmonary complications. Only two patients had a later definitive tracheotomy. Respiratory complications after supracricoid partial laryngectomy are frequent, but can be easily managed in most cases. A preoperative pulmonary assessment is necessary to select patients. During surgery, a precise impaction of the hyoid bone with the cricoid cartilage and a repositioning of an arytenoid can avoid some postoperative stenoses.
本研究旨在分析一系列接受环状软骨上喉部分切除术(或环舌骨会厌固定术或环舌骨固定术)的患者中早期和晚期呼吸并发症的发生率、治疗和预防方法。我们从病历中回顾性分析了 1980 年至 2006 年间因喉鳞状细胞癌接受环状软骨上喉部分切除术的 101 例患者,记录了各种术后并发症和拔管时间。死亡率为 3.96%。早期并发症包括支气管-肺部感染和喉狭窄,发生率为 9.9%。单因素分析显示肺部并发症与颈部清扫术之间存在显著相关性(p < 0.04)。后期则是由于喉阻塞(新喉黏膜瓣、残余假声带折叠或杓状软骨水肿)所致。中位拔管时间为 8 天,拔管延迟与肺部并发症之间存在显著相关性。仅有 2 例患者进行了后期确定性气管切开术。环状软骨上喉部分切除术后的呼吸并发症较为常见,但在大多数情况下可轻松处理。术前需要进行肺部评估以选择患者。在手术中,准确地将舌骨与环状软骨撞击并重新定位杓状软骨可以避免一些术后狭窄。