Basheeth Naveed, O'Leary Gerard, Sheahan Patrick
Department of Otolaryngology - Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland.
Head Neck. 2014 Apr;36(4):580-4. doi: 10.1002/hed.23337. Epub 2013 Oct 16.
Pharyngocutaneous fistula is a serious complication of total laryngectomy. The purpose of this study was to examine predisposing factors at our institution.
We conducted a retrospective review of 94 consecutive patients undergoing total laryngectomy. Cases with hypopharyngeal primary tumors or undergoing extended hypopharyngeal resection with flap augmentation of the pharynx were excluded.
Seventy-four cases met inclusion criteria. A total of 25.7% patients developed a pharyngocutaneous fistula. The fistula rate was higher after salvage laryngectomy than after primary surgery (34.0% vs 11.1%; p = .05). Among salvage laryngectomies, performance of laryngectomy within 1 year of completion of radiotherapy (p = .006) and performance of concomitant bilateral neck dissection (p = .02) were significant risk factors for development of a fistula. Radiation dose, addition of chemotherapy, use of pectoralis major myofascial flap, preoperative tracheostomy, primary puncture, primary tumor subsite, and initial T classification were not significant.
Interval between completion of radiotherapy and surgery is significantly associated with pharyngocutaneous fistula after salvage total laryngectomy.
咽皮肤瘘是全喉切除术的一种严重并发症。本研究的目的是检查我院的易感因素。
我们对94例连续接受全喉切除术的患者进行了回顾性研究。下咽原发性肿瘤患者或接受扩大下咽切除术并采用咽瓣修复术的患者被排除。
74例符合纳入标准。共有25.7%的患者发生了咽皮肤瘘。挽救性喉切除术后的瘘管发生率高于初次手术后（34.0%对11.1%；p = 0.05）。在挽救性喉切除术中，放疗结束后1年内进行喉切除术（p = 0.006）和同期双侧颈清扫术（p = 0.02）是发生瘘管的显著危险因素。放射剂量、化疗的添加、胸大肌肌筋膜瓣的使用、术前气管切开术、初次穿刺、原发肿瘤部位和初始T分类均无显著意义。
放疗结束与手术之间的间隔时间与挽救性全喉切除术后的咽皮肤瘘显著相关。
