Department of Oto-Rhino-Laryngology, Hospital Universitario Sant Joan, Reus, Spain.
Head Neck. 2011 May;33(5):679-85. doi: 10.1002/hed.21521. Epub 2010 Aug 24.
The aim of this study was to evaluate the incidence, risk factors, management, and outcome of postoperative aspiration in patients managed with a supracricoid partial laryngectomy (SCPL) for selected invasive squamous carcinoma of the larynx.
In all, 457 patients underwent SCPL at an academic, tertiary referral care center, 1975-2000. The incidence of aspiration defined in accord with Pearson's scale was recorded. Univariate and multivariate analyses were performed for potential statistical relation with various variables. The management and outcome of aspiration are presented.
Normal swallowing without aspiration was noted in 259 patients (58.9%). Grades 1, 2, and 3 aspiration occurred in 87, 48, and 53 patients (19%, 10.5%, and 11.6%), respectively. A significant relationship was noted between aspiration and increased age, performing cricohyoidopexy, not repositioning the pyriform sinuses, and resecting an arytenoid cartilage. A prediction model, based on multinomial logistic regression, found that the probability that severe aspiration cases (grade 2-3) exceeded the subclinical ones (grade 0-1) occurred only when a cricohyoidopexy with partial or total arytenoid resection was performed in patients >70 years of age (p = .0000001). Management of aspiration required a temporary gastrostomy, a permanent gastrostomy, and a completion total laryngectomy in 65, 3, and 7 of 188 patients (34.5%, 1.6%, and 3.7%, respectively) who aspirated, and 65, 3, and 7 of 457 of the entire population (14.2%, 0.6%, and 1.5%, respectively). Aspiration-related death was not encountered in the current series.
Aspiration after SCPL is a common but rarely severe event, with a low incidence for permanent gastrostomy or completion laryngectomy. Aspiration can be minimized with careful patient selection and precise surgical technique.
本研究旨在评估采用环状软骨上喉次全切除术（SCPL）治疗特定侵袭性喉鳞癌患者的术后吸入发生率、危险因素、处理方法和结局。
1975 年至 2000 年，共有 457 例患者在一家学术性三级转诊中心接受 SCPL。根据 Pearson 量表记录吸入的发生率。对各种变量与潜在统计学关系进行单变量和多变量分析。介绍吸入的处理方法和结局。
259 例（58.9%）患者吞咽正常且无吸入。87 例（19%）、48 例（10.5%）和 53 例（11.6%）患者发生 1 级、2 级和 3 级吸入。吸入与年龄增长、施行环甲膜舌骨固定术、未重新定位梨状隐窝和切除杓状软骨之间存在显著关系。基于多项逻辑回归的预测模型发现，只有当年龄＞70 岁的患者行环甲膜舌骨固定术联合部分或全部杓状软骨切除术时，严重吸入病例（2-3 级）的概率才会超过亚临床病例（0-1 级）（p=0.0000001）。188 例发生吸入的患者中，65 例需要临时胃造口术、3 例需要永久胃造口术、7 例需要完成全喉切除术，而在 457 例全部患者中，65 例需要临时胃造口术、3 例需要永久胃造口术、7 例需要完成全喉切除术（34.5%、1.6%和 3.7%，分别）。本系列研究中未发生与吸入相关的死亡。
SCPL 后发生吸入是一种常见但很少严重的事件，永久胃造口术或完成全喉切除术的发生率较低。通过仔细的患者选择和精确的手术技术，可以最大限度地减少吸入。
