Wax M K, Touma B J, Ramadan H H
Department of Otolaryngology, West Virginia University, Morgantown 26505, USA.
Otolaryngol Head Neck Surg. 1995 Sep;113(3):242-7. doi: 10.1016/S0194-5998(95)70112-5.
Laryngectomy for carcinoma of the larynx has been performed since it was first described in 1880. Since that time the complication of tracheostomal stenosis has plagued both surgeons and patients. The reported incidence of tracheostomal stenosis ranges from 4% to 42%. At West Virginia University Hospitals from 1976 to 1994, 106 patients undergoing laryngectomies on the head and neck oncology service were analyzed. The charts of patients treated before 1991 were reviewed retrospectively; a prospective analysis was initiated in 1991. Only patients with a minimum of 6 months of follow-up were included in this study. The male-to-female ratio was 3:1, with an age range of 28 to 86 years (mean, 58 years). The overall rate of stenosis was 28.4%. The incidence of tracheostomal stenosis was higher in women (46.4%) than in men (21.6%) (p < 0.05). Since 1991 a plastic type of closure was used in 25 patients. The stenosis rate was 0% in these patients. Before 1991 a bevel or circle technique was used, with stenosis rates of 33% and 75%, respectively (p < 0.05). Infection at the site of the stoma, fistula, steroid use, neck dissection, pectoralis major myocutaneous flap usage, primary tracheoesophageal puncture, and radiotherapy did not correlate with an increased incidence of stenosis. The most important factor in prevention of stomal stenosis after laryngectomy is attention to detail while forming the stoma. With good technique and a plastic-type closure to break up the suture line, a minimal rate of stenosis should be encountered.
自1880年首次描述以来，喉癌患者一直接受喉切除术治疗。从那时起，气管造口狭窄的并发症一直困扰着外科医生和患者。报道的气管造口狭窄发生率在4%至42%之间。1976年至1994年期间，对西弗吉尼亚大学医院头颈肿瘤服务部接受喉切除术的106例患者进行了分析。对1991年以前接受治疗的患者病历进行了回顾性研究；1991年开始进行前瞻性分析。本研究仅纳入随访至少6个月的患者。男女比例为3:1，年龄范围为28至86岁（平均58岁）。总体狭窄率为28.4%。女性气管造口狭窄的发生率（46.4%）高于男性（21.6%）（p<0.05）。自1991年以来，25例患者采用了整形闭合术。这些患者的狭窄率为0%。1991年以前采用了斜面或圆形技术，狭窄率分别为33%和75%（p<0.05）。造口部位感染、瘘管形成、使用类固醇、颈部清扫、胸大肌肌皮瓣使用、一期气管食管穿刺和放疗与狭窄发生率增加无关。喉切除术后预防造口狭窄的最重要因素是在形成造口时注重细节。采用良好的技术和整形闭合术来打破缝线，狭窄发生率应降至最低。
