Johansen L V, Overgaard J, Elbrønd O
ENT Department, Aarhus University Hospital, Denmark.
Cancer. 1988 Feb 15;61(4):673-8. doi: 10.1002/1097-0142(19880215)61:4<673::aid-cncr2820610410>3.0.co;2-c.
The development of a pharyngocutaneous fistulae is a major complication after total laryngectomy. In Denmark radiotherapy is the primary treatment for all laryngeal carcinomas. Based on the experience with conventional daily irradiation, a split-course radiation schedule was introduced in 1978. The charts of 106 consecutive patients laryngectomized for recurrence in the years 1975 to 1984 were examined. Thirty-four patients developed a fistula. An evaluation of the different radiotherapy schedules used during this period allowed a dose-response curve to be constructed. It showed a pronounced increase of fistulae with high doses of radiotherapy. Split-course radiotherapy caused a rise in late complications and did not improve tumor control. Large field sizes increased the number of fistulae. High-dose fractions showed a surprisingly high incidence of late complications. Prophylactic metronidazole (introduced in 1980) resulted in a highly significant decrease in the frequency of postoperative fistulae. Patients in whom fistula formed were hospitalized for an average of 54 days, patients without, for 22 days.
咽皮肤瘘是全喉切除术后的主要并发症。在丹麦，放射治疗是所有喉癌的主要治疗方法。基于常规每日照射的经验，1978年引入了分段放射治疗方案。对1975年至1984年间因复发而行喉切除术的106例连续患者的病历进行了检查。34例患者发生了瘘管。对这一时期使用的不同放射治疗方案进行评估后构建了剂量反应曲线。结果显示，高剂量放射治疗时瘘管明显增加。分段放射治疗导致晚期并发症增加，且未改善肿瘤控制。大野照射增加了瘘管的数量。高剂量分次照射显示晚期并发症的发生率惊人地高。预防性使用甲硝唑（1980年引入）使术后瘘管的发生率显著降低。发生瘘管的患者平均住院54天，未发生瘘管的患者平均住院22天。
