全喉切除术后气管食管造瘘口扩大的多因素分析。
Multivariable analysis of risk factors for enlargement of the tracheoesophageal puncture after total laryngectomy.
机构信息
Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
出版信息
Head Neck. 2012 Apr;34(4):557-67. doi: 10.1002/hed.21777. Epub 2011 Jun 20.
BACKGROUND
Enlarged tracheoesophageal puncture (TEP) is a challenging complication of surgical prosthetic voice restoration. Prevention of this complication requires identification of high-risk individuals, and surgical and prosthetic correlates of TEP enlargement.
METHODS
Multivariable logistic regression methods were used to analyze preoperative, perioperative, and postoperative risk factors for enlarged TEP in a 5-year retrospective cohort.
RESULTS
Enlarged TEP only occurred in irradiated patients. Adjusting for length of follow-up and timing of TEP, advanced (N2 or N3) nodal disease (odds ratio OR , 4.3; 95% confidence interval [CI], 1.0-19.1), postoperative stricture (OR(adjusted) , 3.2; 95% CI, 1.2-8.6), and diagnosis of locoregional recurrence or distant metastasis after laryngectomy (OR(adjusted) , 6.2; 95% CI, 2.3-16.4) increased risk of enlarged TEP. Extended resection and preoperative nutritional status were also significantly associated with enlarged TEP. Prosthetic parameters did not significantly correlate with enlargement.
CONCLUSION
Development of enlarged TEP is a multifactorial process related to both baseline and postoperative factors.
背景
扩大的气管食管造口术（TEP）是手术假体语音修复的一种具有挑战性的并发症。预防这种并发症需要确定高危人群，以及 TEP 扩大的手术和假体相关性。
方法
多变量逻辑回归方法用于分析 5 年回顾性队列中扩大 TEP 的术前、围手术期和术后危险因素。
结果
仅在接受放疗的患者中发生扩大的 TEP。调整随访时间和 TEP 时间后，晚期（N2 或 N3）淋巴结疾病（优势比[OR]（调整），4.3；95%置信区间[CI]，1.0-19.1）、术后狭窄（OR（调整），3.2；95%CI，1.2-8.6）和喉切除术后局部区域复发或远处转移的诊断（OR（调整），6.2；95%CI，2.3-16.4）增加了 TEP 扩大的风险。广泛切除和术前营养状况也与 TEP 扩大显著相关。假体参数与扩大无显著相关性。
结论
TEP 的扩大是一个与基线和术后因素相关的多因素过程。
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