喉癌及下咽癌病患接受全喉切除手術之術後併發症

Postoperative Complications of Total Laryngectomy in Laryngeal and Hypopharyngeal Carcinoma Patients

蔡奇孟(Chi-Meng Tsai) ； 黃澤人(Tzer-Zen Hwang)

《台灣耳鼻喉頭頸外科雜誌》 38卷4期 (2003/08) Pp. 139-145

https://doi.org/10.6286/2003.38.4.139

摘要

背景：全喉切除手術後併發症的產生可能會延長住院時間、需要額外手術、產生永久性後遺症，甚至有致命的危險。本研究目的在於探討全喉切除手術後之各種術後併發症之發生率，及一些可能影響併發症產生的因素對併發症發生率之影響。
方法：以自1988年至2000年間，89名診斷為喉癌或下咽癌且接受全喉切除手術的病患為研究對象。我們以回溯研究的方式，統計各種術後併發症之發生率，並分析診斷為喉癌或下咽癌、是否接受放射線治療、是否接受頸部廓清手術，及是否接受重建手術等影響因素，對術後併發症發生率之影響。
結果：術後主要併發症的發生率為34.8%，發生率高低依序為咽皮管19.1%、氣管造口狹窄18.0%、傷口感染9.0%、肺炎6.7%、上消化道出血5.6%、食道狹窄5.6%、頸動脈破裂3.4%及乳糜管2.2%。次要併發症主要是傷口癒合不良，發生率為25.8%。各個影響因素對主要併發症整體發生率之影響，都沒有呈現統計學上有意義的差異，但診斷為下咽癌者，咽皮管的發生率較高；合併接受重建手術的病患，氣管造口狹窄的發生率較高。而各個影響因素對傷口感染都沒有呈現統計學上有意義的差異。6名併發肺炎中，有2名死亡。下咽癌術後食道狹窄發生率較高。頸動脈破裂皆發生於合併接受頸部廓病患。併發乳糜管者皆有接受頸部廓清手術。
結論：1)全喉切除手術若合併游離瓣重建手術，整體術後併發症的發生率較高。2)下咽癌需接受游離瓣重建手術者，咽皮管的發生率較高。接受游離瓣重建手術的病患，氣管造口狹窄的發生率較高，放射線治療則並未明顯增高氣管造口狹窄的發生率。3)各個影響因素對傷口感染發生率之影響並沒有明顯差異；下咽癌術後食道狹窄的發生率較高。4)嚴重心肺併發症以及頸動脈破裂，可能造成死亡，須特別注意。

關鍵字

全喉切除術 ； 併發症

並列摘要

BACKGROUND: Complications after total laryngectomy may lead to prolonged hospitalization, further surgery, permanent sequela, and mortality. This study analyzed the postoperative complications of total laryngectomy.
METHODS: Between 1988 and 2000, 89 patients with laryngeal or hypopharyngeal cancer underwent total laryngectomy at our hospital. The incidence and management of complications were evaluated. Complications were also studied in relation to laryngeal or hypopharyngeal cancer, neck dissection, radiotherapy, and the type of reconstruction.
RESULTS: The overall complication rate was 58.4%. The major complication rate was 34.8%. Pharyngocutaneous fistula was the most frequent major complication (19.1%), followed by tracheostomal stenosis (18.0%), wound infection, pneumonia, upper gastrointestinal bleeding, esophageal stenosis, carotid artery rupture, and chyle fistula formation.
CONCLUSIONS: No statistically significant difference in major complication rates was observed between patients with laryngeal or hypopharyngeal cancer, with or without neck dissection, with or without radiotherapy, and with or without reconstruction. Pharyngocu-taneous fistula and tracheostomal stenosis were frequent major complications. Patients with hypopharyngeal cancer had a higher pharyngocutaneous fistula formation rate. Patients with flap reconstruction had a higher tracheostomal stenosis rate. No significant difference in tracheostomal stenosis rate was found in patients with or without preoperative or postoperative radiotherapy. Carotid artery rupture and medical complications can cause mortality.

並列關鍵字

total laryngectomy ； complications