Bharathi M B, Janga Rajendra Prasad, Rakesh B S, Babu A R
1Department of ENT, JSS Hospital and University, Mysuru, India.
2Department of ENT, JSS Medical College and JSS University, Mysuru, 506331 India.
Indian J Otolaryngol Head Neck Surg. 2019 Oct;71(Suppl 1):489-496. doi: 10.1007/s12070-018-1366-8. Epub 2018 Apr 24.
Complications following the total laryngectomy with or without partial pharyngectomy with neck dissection for laryngeal and pyriform fossa malignancies like aspiration, pharyngocutaneous fistula wound infection, flap necrosis, haematoma, chyle fistula and carotid blowout can cause serious implication on the final outcome of the treatment, which leads to increased postoperative morbidity, hospital stay and hospital cost. A prospective study in the Department of Otolaryngology and Head-Neck Surgery, JSS Hospital, Mysore, from November 2014 to July 2016. 30 patients undergoing Total laryngectomy with or without partial pharyngectomy for laryngeal and pyriform fossa were included in this study. The presentation, diagnosis, and management of the complications that were occurred, were discussed. The age of the patients vary between 32 and 76. Also, male preponderance was seen with approximately M:F ratio 3:1. Out of these 30 patients, 6 patients developed complications. The most common complication was pharyngocutaneous fistula (2 patients, 6%), which was developed after the 7th day. It was managed conservatively in both patients, wound infection was a second complication (2, 6%). Other complications were drain failure (1, 3%) and chylous fistula (1, 3%). The Most common complications after total laryngectomy with or without partial pharyngectomy with neck dissection in our study were wound infection and pharyngocutaneous fistula. Assessment of risk factors, early recognition of complications per operative protocols with improvised techniques are necessary to reduce incidence of complication after total laryngectomy with or without partial pharyngectomy with neck dissection.
对于喉癌和梨状窝恶性肿瘤行全喉切除术加或不加部分咽切除术并颈清扫术，术后并发症如误吸、咽皮肤瘘、伤口感染、皮瓣坏死、血肿、乳糜瘘和颈动脉破裂，可对治疗的最终结果产生严重影响，导致术后发病率增加、住院时间延长和住院费用增加。2014年11月至2016年7月在迈索尔JSS医院耳鼻咽喉头颈外科进行了一项前瞻性研究。本研究纳入了30例行全喉切除术加或不加部分咽切除术治疗喉癌和梨状窝恶性肿瘤的患者。讨论了所发生并发症的表现、诊断和处理。患者年龄在32岁至76岁之间。此外，男性占优势，男女比例约为3:1。在这30例患者中，6例出现并发症。最常见的并发症是咽皮肤瘘（2例，6%），在术后第7天之后出现。两名患者均采用保守治疗，伤口感染是第二大并发症（2例，6%）。其他并发症为引流失败（1例，3%）和乳糜瘘（1例，3%）。在我们的研究中，全喉切除术加或不加部分咽切除术并颈清扫术后最常见的并发症是伤口感染和咽皮肤瘘。评估危险因素，按照手术方案通过改进技术早期识别并发症，对于降低全喉切除术加或不加部分咽切除术并颈清扫术后并发症的发生率是必要的。
