【摘要】：目的:分析喉癌術(shù)后感染的相關(guān)因素,探討喉癌術(shù)后發(fā)生感染的主要原因,并針對(duì)其原因提出防治建議。方法:回顧性分析吉林大學(xué)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(shù)患者的臨床資料,將無(wú)術(shù)后感染及術(shù)后頸深部感染(包括含咽瘺的頸深部感染和無(wú)咽瘺的頸深部感染)分2組,其中有54例發(fā)生術(shù)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(jì)學(xué)軟件進(jìn)行分析,卡方檢驗(yàn)統(tǒng)計(jì)出影響喉癌術(shù)后感染的因素,并從中選出明顯影響術(shù)后感染的穩(wěn)定性因素建立Logistic多因素回歸分析模型,檢驗(yàn)水準(zhǔn)α=0.05并以表格的形式描述結(jié)果。結(jié)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(shù)后感染54例(15.8%),咽瘺17例(5.0%)。術(shù)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(shù)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(fù)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(shù)者156例,其中感染31例,咽瘺5例(3.2%)。術(shù)前有基礎(chǔ)疾病(糖尿病)16例,其中感染5例,咽瘺2例(12.5%),無(wú)糖尿病326例,感染48例,咽瘺15例(4.6%)。單因素分析結(jié)果表明:臨床分期、腫瘤分期、住院時(shí)長(zhǎng)、術(shù)前氣管切開、喉癌術(shù)式、同期頸部淋巴結(jié)清掃、留置引流管、安全緣、手術(shù)時(shí)長(zhǎng)等9個(gè)單因素與術(shù)后感染的發(fā)生有統(tǒng)計(jì)學(xué)意義(P0.05)。在此基礎(chǔ)上建立Logistic多因素回歸分析模型,最終得出結(jié)果酗酒史、手術(shù)時(shí)間、腫瘤分期、手術(shù)方式是術(shù)后感染發(fā)生的獨(dú)立影響因素。結(jié)論:喉癌術(shù)后常見(jiàn)頸深部感染,其導(dǎo)致感染的原因與酗酒史、手術(shù)時(shí)間、腫瘤分期、手術(shù)方式、術(shù)前氣管切開有關(guān)。術(shù)前氣管切開、手術(shù)時(shí)間、腫瘤分期及手術(shù)方式之間具有相關(guān)性,腫瘤分期高,腫瘤侵及范圍廣,手術(shù)復(fù)雜需要的手術(shù)時(shí)間長(zhǎng),術(shù)后發(fā)生感染的風(fēng)險(xiǎn)高,術(shù)前氣管切開喉癌術(shù)后感染的風(fēng)險(xiǎn)增加;其次全喉切除術(shù)比部分喉切除術(shù)術(shù)后發(fā)生感染的風(fēng)險(xiǎn)高。影響喉癌術(shù)后感染的因素很多,我們的目的是針對(duì)合并高危因素喉癌患者,積極改善、解決、避免上訴相關(guān)的因素,盡量降低術(shù)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，

本文編號(hào)：2192512