本文選題：咽瘺 + 喉癌　； 參考：《鄭州大學(xué)》2011年碩士論文

【摘要】：目的 分析喉癌、下咽癌術(shù)后咽瘺的主要原因,根據(jù)分析結(jié)果提出相應(yīng)預(yù)防措施。 方法 收集2009年1月1日到2011年1月1日期間,經(jīng)鄭州大學(xué)第一附屬醫(yī)院耳鼻喉科收治的198例喉癌下咽癌(包括187例喉癌和11例下咽癌)手術(shù)患者的完整病例資料,使用SPSS10.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。 結(jié)果 187例喉癌患者術(shù)后18例(9.6%)發(fā)生咽瘺,11例下咽癌患者術(shù)后3例(27.3%)發(fā)生咽瘺。全組病例除1例梭形細(xì)胞軟組織肉瘤外,其余197例均為喉(或下咽)鱗狀細(xì)胞癌。統(tǒng)計(jì)學(xué)分析結(jié)果顯示,咽瘺發(fā)生的主要影響因素有：是否合并糖尿病,有無(wú)術(shù)前放療,喉切除術(shù)前是否行氣管切開,腫瘤分期,手術(shù)方式,同期有無(wú)行頸淋巴結(jié)清掃以及術(shù)后48小時(shí)內(nèi)體溫是否持續(xù)高于37.5度�；颊叩哪挲g、性別,腫瘤生長(zhǎng)部位及手術(shù)時(shí)間等與咽瘺的發(fā)生無(wú)統(tǒng)計(jì)學(xué)意義。資料表明合并糖尿病,術(shù)前接受放療和氣管切開,腫瘤Ⅲ期、Ⅳ期,行喉全切除和(或)下咽切除術(shù),同期行頸淋巴結(jié)清掃,術(shù)后48小時(shí)內(nèi)體溫高于37.5度的患者術(shù)后并發(fā)咽瘺的幾率明顯大于無(wú)糖尿病,術(shù)前未行放療和氣管切開,腫瘤Ⅰ-Ⅱ期,行喉部分切除,未行頸淋巴結(jié)清掃術(shù),術(shù)后體溫?zé)o明顯升高的患者。 結(jié)論 咽瘺發(fā)生的高危因素主要有以下幾點(diǎn)：1、術(shù)前血紅蛋白低于正常值；2、術(shù)前合并糖尿��；3、術(shù)前接受放療；4、術(shù)前行氣管切開；5、腫瘤Ⅲ期-Ⅳ期；6、行喉全切除(或包括下咽部分切除)術(shù)；7、同期行頸淋巴結(jié)清掃術(shù)；8、術(shù)后48小時(shí)內(nèi)體溫持續(xù)高于37.5度。 對(duì)于合并以上高危因素的喉癌、下咽癌患者,須于術(shù)前將其營(yíng)養(yǎng)狀況調(diào)整至最佳；術(shù)中嚴(yán)格把握手術(shù)適應(yīng)癥,尤其應(yīng)規(guī)范頸淋巴結(jié)的處理,避免漏診的同時(shí)應(yīng)注意減少患者不必要的創(chuàng)傷；術(shù)后加強(qiáng)護(hù)理。如此才能最大限度的減少咽瘺發(fā)生,減輕患者的負(fù)擔(dān)。
[Abstract]:Purpose The main causes of postoperative pharyngeal fistula in laryngeal carcinoma and hypopharyngeal carcinoma were analyzed and corresponding preventive measures were put forward. Method From January 1, 2009 to January 1, 2011, 198 patients with hypopharyngeal carcinoma (including 187 laryngeal cancer and 11 hypopharyngeal carcinoma) treated by the otolaryngology department of the first affiliated Hospital of Zhengzhou University were collected. SPSS10.0 software was used for statistical analysis. Result Pharyngeal fistula occurred in 18 patients with laryngeal carcinoma (n = 18) and pharyngeal fistula in 11 patients with hypopharyngeal carcinoma (n = 3). All the 197 cases were squamous cell carcinoma of larynx (or hypopharynx) except one spindle cell soft tissue sarcoma. The results of statistical analysis showed that the main factors influencing the occurrence of pharyngeal fistula were: diabetes mellitus, preoperative radiotherapy, tracheotomy before laryngectomy, tumor staging, operation methods, Neck lymph node dissection was performed at the same time and body temperature was higher than 37.5 degrees within 48 hours after operation. Age, sex, tumor site and operative time were not significantly associated with the occurrence of pharyngeal fistula. Data showed that with diabetes, preoperative radiotherapy and tracheotomy, stage 鈪，

本文編號(hào)：1802646