發(fā)布時間：2018-08-19 18:50

【摘要】：目的:分析喉癌術后感染的相關因素,探討喉癌術后發(fā)生感染的主要原因,并針對其原因提出防治建議。方法:回顧性分析吉林大學白求恩第一醫(yī)院2011年1月至2015年12月診治的342例喉癌手術患者的臨床資料,將無術后感染及術后頸深部感染(包括含咽瘺的頸深部感染和無咽瘺的頸深部感染)分2組,其中有54例發(fā)生術后頸深部感染(感染率為15.8%),包括咽瘺17例,采用SPSS22.0統(tǒng)計學軟件進行分析,卡方檢驗統(tǒng)計出影響喉癌術后感染的因素,并從中選出明顯影響術后感染的穩(wěn)定性因素建立Logistic多因素回歸分析模型,檢驗水準α=0.05并以表格的形式描述結果。結果:共收集資料342例,年齡36~60(不包括60)歲患者164例,≥60歲者178例,平均年齡(60.08±8.69)歲,其中術后感染54例(15.8%),咽瘺17例(5.0%)。術前放療患者3例,其中感染2例(66.7%),咽瘺1例(33.3%);未放療者339例,其中感染51例(15.0%),咽瘺16例(31.4%)。術前氣管切開者29例,其中咽瘺5例(17.2%),未氣切者313例,咽瘺12例(3.8%)。臨床分期:0-Ⅱ期139例,其中感染12例,咽瘺2例(16.7%),Ⅲ期52例,其中感染8例,咽瘺2例(3.8%),Ⅳ期59例,其中感染17例,咽瘺7例(11.9%)。腫瘤分型,聲門上型125例,其中感染30例,咽瘺10例(8.0%),聲門型203例,其中感染17例,咽瘺3例(1.4%),貫聲門型8例,其中感染者3例,咽瘺1例(12.5%),喉癌復發(fā)6例,感染3例,均為咽瘺(50%)。全喉切除者75例,其中感染22例,咽瘺12例(16.0%),喉部分切除術者156例,其中感染31例,咽瘺5例(3.2%)。術前有基礎疾病(糖尿病)16例,其中感染5例,咽瘺2例(12.5%),無糖尿病326例,感染48例,咽瘺15例(4.6%)。單因素分析結果表明:臨床分期、腫瘤分期、住院時長、術前氣管切開、喉癌術式、同期頸部淋巴結清掃、留置引流管、安全緣、手術時長等9個單因素與術后感染的發(fā)生有統(tǒng)計學意義(P0.05)。在此基礎上建立Logistic多因素回歸分析模型,最終得出結果酗酒史、手術時間、腫瘤分期、手術方式是術后感染發(fā)生的獨立影響因素。結論:喉癌術后常見頸深部感染,其導致感染的原因與酗酒史、手術時間、腫瘤分期、手術方式、術前氣管切開有關。術前氣管切開、手術時間、腫瘤分期及手術方式之間具有相關性,腫瘤分期高,腫瘤侵及范圍廣,手術復雜需要的手術時間長,術后發(fā)生感染的風險高,術前氣管切開喉癌術后感染的風險增加;其次全喉切除術比部分喉切除術術后發(fā)生感染的風險高。影響喉癌術后感染的因素很多,我們的目的是針對合并高危因素喉癌患者,積極改善、解決、避免上訴相關的因素,盡量降低術后感染的發(fā)生。
[Abstract]:Objective: to analyze the related factors of postoperative infection of laryngeal carcinoma, to explore the main causes of postoperative infection of laryngeal carcinoma, and to put forward suggestions for prevention and treatment. Methods: the clinical data of 342 patients with laryngeal carcinoma treated in Bethune first Hospital of Jilin University from January 2011 to December 2015 were retrospectively analyzed. The patients were divided into two groups: no postoperative infection and deep cervical infection (including deep neck infection with pharyngeal fistula and deep neck infection without pharyngeal fistula). Among them, 54 cases had postoperative deep cervical infection (infection rate was 15.8%), including 17 cases of pharyngeal fistula. The factors influencing postoperative infection of laryngeal carcinoma were analyzed by SPSS22.0 software and chi-square test, and the stability factors of postoperative infection were selected to establish Logistic multivariate regression model. Test level 偽 0.05 and describe the results in tabular form. Results: 342 cases were collected, 164 cases were aged 36 ~ 60 (excluding 60), 178 cases were 鈮，

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