Comparison of pharyngocutaneous fistula after total laryngectomy with thyroid gland flap and traditional strap muscle
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摘要: 目的 对比全喉切除术应用带蒂甲状腺组织瓣与传统带状肌修复术后咽瘘的发生差异，寻找降低全喉切除术后咽瘘的有效修复方式。方法 60例局部晚期喉恶性肿瘤患者随机分成2组，每组各30例。全喉切除施行后实验组采用带蒂甲状腺组织瓣修复加固咽吻合口，对照组采用传统带状肌修复加固咽吻合口。收集2组患者性别、年龄、术中出血量、手术时间、颈淋巴结清扫、合并糖尿病、术后低蛋白血症、肿瘤分期、修复方式及术后咽瘘的数据，比较2组患者咽瘘的发生率，应用logistic回归分析寻找全喉术后咽瘘的独立危险因素。结果 全喉切除术后采用带蒂甲状腺组织瓣修复术后咽瘘的发生率为3.3%(1/30)，采用传统带状肌修复术后咽瘘的发生率26.7%(8/30)，差异有统计学意义(P < 0.05)。性别、年龄、术中出血量、手术时间、颈淋巴结清扫、糖尿病、肿瘤分期与咽瘘之间未呈现出显著相关性；术后低蛋白血症和修复方式与咽瘘发生具有相关性；修复方式是全喉切除术后咽瘘的一个独立危险因素。结论 全喉切除术应用带蒂甲状腺组织瓣修复较传统带状肌修复术后咽瘘发生率明显降低，其可作为一种有效地降低术后咽瘘的临床手术修复方式。Abstract: Objective Compare the difference of Pharyngocutaneous fistula after total laryngectomy using thyroid gland flap and traditional strip muscle repair, find an effective way to reduce Pharyngocutaneous fistula after total laryngectomy.Methods Sixty patients with locally advanced laryngeal malignancies were randomly divided into two groups with 30 cases in each group. After total laryngectomy, the experimental group was repaired with thyroid gland flap, and the control group was repaired with traditional strap muscle. Data of gender, age, intraoperative blood loss, operation time, neck lymph node dissection, combined diabetes mellitus, postoperative hypoproteinemia, tumor stage, repair mode and postoperative Pharyngocutaneous fistula were collected in the two groups. The incidence of Pharyngocutaneous fistula in the two groups was compared, and the independent risk factors of Pharyngocutaneous fistula after total laryngectomy were found by logistic regression analysis.Results The incidence of Pharyngocutaneous fistula after total laryngectomy was 3.3%(1/30) in patients with thyroid gland flap repair and 26.7% (8/30) in patients with traditional strip muscle repair, with statistically significant difference(P < 0.05). There was no significant correlation between gender, age, maximum tumor diameter, blood loss, operation time and Pharyngocutaneous fistula. Hypoproteinemia and repair mode were correlated with pharyngocutaneous fistula. Repair mode is an independent risk factor for Pharyngocutaneous fistula after total laryngectomy.Conclusion The occurrence of Pharyngocutaneous fistula after total laryngectomy was decreased significantly by using pedicle thyroid flap compare to traditional surgery.The Pedicle thyroid flap can be considered as an effective clinical repairment to reduce postoperative Pharyngocutaneous fistula.
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Key words:
- pharyngocutaneous fistula /
- thyroid gland flap /
- total laryngectomy
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表 1 2组患者一般资料及术后咽瘘的发生率比较
项目 带状肌修复组
(n=30)甲状腺瓣修复组
(n=30)t/χ2 P 性别/例 0.517 0.472 男 28 30 女 2 0 年龄/岁 64.00± 9.18 62.00± 7.67 0.916 0.363 术中出血量/mL 100.50± 18.30 101.67± 29.72 -0.183 0.855 手术时间/min 177.67± 13.57 180.00± 16.14 -0.606 0.547 颈淋巴结清扫/例 2.069 0.150 有 28 30 无 2 0 糖尿病/例 0.647 0.421 无 25 28 有 5 2 术后低蛋白血症/例 1.667 0.197 无 25 29 有 5 1 肿瘤分期/例 0.317 0.573 Ⅲ期 10 8 Ⅳ期 20 22 咽瘘/例 4.706 0.030 无 22 29 有 8 1 
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表 2 咽瘘相关危险因素单因素分析
例 影响因素 有咽瘘组
(n=9)无咽瘘组
(n=51)χ2/确切概率法 P 性别 1.000 0.720 男 9 49 女 0 2 年龄 0.811 0.368 >60岁 4 34 ≤ 60岁 5 17 术中出血量 2.361 0.124 >100 mL 4 8 ≤ 100 mL 5 43 手术时间 0.255 0.613 >180 min 4 15 ≤ 180 min 5 36 肿瘤分期 3.013 0.083 Ⅲ期 0 18 Ⅳ期 9 33 颈淋巴结清扫 1.000 0.720 有 9 49 无 0 2 合并糖尿病 0.384 0.536 有 0 7 无 9 44 低蛋白血症(< 25 g/L) < 0.01 有 5 1 无 4 50 修复方式 4.706 0.030 甲状腺瓣 1 29 带状肌瓣 8 22
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