全喉切除术后咽皮肤瘘危险因素的预测价值

Predictive Value of Risk Factors for Pharyngocutaneous Fistula After Total Laryngectomy.

作者信息

Kim Do Hyun, Kim Sung Won, Hwang Se Hwan

机构信息

Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.

Department of Otolaryngology-Head and Neck Surgery, Bucheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.

出版信息

Laryngoscope. 2023 Apr;133(4):742-754. doi: 10.1002/lary.30278. Epub 2022 Jun 29.

DOI:10.1002/lary.30278

PMID:35769042

Abstract

OBJECTIVES

To assess the predictive value of various risk factors for pharyngocutaneous fistula (PCF) after total laryngectomy.

METHODS

The characteristics of each study were collected from six databases up to January of 2022. Risk for bias was assessed using the QUADAS-2 tool.

RESULTS

A total of 58 studies in 9845 patients were included in the analysis. The incidence of PCF was 21.69%, 95% confidence intervals (CI) [0.20; 0.24] in the included studies. Age (OR = 1.33, 95% CI [1.12; 1.58]), postoperative anemia (OR = 2.29, 95% CI [1.47; 3.57]), diabetes mellitus (OR = 1.81, 95% CI [1.20; 2.71]), tumor site (above or below the glottis) (OR = 1.47, 95% CI [1.15; 1.88]), previous radiation therapy (OR = 2.06, 95% CI [1.56; 2.72]), previous tracheostomy (OR = 1.26, 95% CI [1.04; 1.53]), surgery timing (salvage vs. primary) (OR = 2.08, 95% CI [1.46; 2.97]), extended total laryngectomy (including pharyngectomy) (OR = 1.96, 95% CI [1.28; 3.00]), primary tracheoesophageal puncture (OR = 0.61, 95% CI [0.40; 0.93]), and postoperative hypoproteinemia (OR = 9.98, 95% CI [3.68; 27.03]) were significantly associated with the occurrence of PCF. In view of predictive ability, postoperative hypoproteinemia showed the highest accuracy (sensitivity = 51%, specificity = 90%, area under the curve = 0.84).

CONCLUSION

Multiple patient-, disease-, and surgery-related factors are risk factors for PCF. In particular, postoperative hypoproteinemia could be a good predictive factor for PCF in patients undergoing total laryngectomy. Laryngoscope, 133:742-754, 2023.

摘要

目的

评估全喉切除术后咽皮肤瘘（PCF）各种危险因素的预测价值。

方法

截至2022年1月，从六个数据库收集每项研究的特征。使用QUADAS - 2工具评估偏倚风险。

结果

分析共纳入9845例患者的58项研究。纳入研究中PCF的发生率为21.69%，95%置信区间（CI）[0.20；0.24]。年龄（比值比[OR]=1.33，95%CI[1.12；1.58]）、术后贫血（OR=2.29，95%CI[1.47；3.57]）、糖尿病（OR=1.81，95%CI[1.20；2.71]）、肿瘤部位（声门上方或下方）（OR=1.47，95%CI[1.15；1.88]）、既往放疗（OR=2.06，95%CI[1.56；2.72]）、既往气管切开术（OR=1.26，95%CI[1.04；1.53]）、手术时机（挽救性手术与初次手术）（OR=2.08，95%CI[1.46；2.97]）、扩大全喉切除术（包括咽切除术）（OR=1.96，95%CI[1.28；3.00]）、一期气管食管穿刺（OR=0.61，95%CI[0.40；0.93]）和术后低蛋白血症（OR=9.98，95%CI[3.68；27.03]）与PCF的发生显著相关。就预测能力而言，术后低蛋白血症显示出最高的准确性（敏感性=51%，特异性=90%，曲线下面积=0.84）。