| At present,there are many clinical treatments for laryngeal cancer,but surgical treatment is still widely used.The main principle of surgical treatment of laryngeal cancer is to completely resect the tumor tissue and preserve the laryngeal function of patients as much as possible.After partial laryngectomy,all or most of the functions of the larynx can be preserved to a certain extent by various repair methods,which is conducive to further promoting the improvement of the quality of life of patients.However,there are also some problems in the operation of laryngeal function.Some patients may have complications such as life-long tracheal cannula and poor recovery of swallowing function after operation.Once the cannula cannot be removed,the patients will not only be able to recover their voice as soon as possible,but also may need a second operation to treat the problem of cannula removal,which not only increases the physiological and psychological burden of patients,but also prolongs their hospitalization time and increases the cost of hospitalization,leading to further decline in the quality of life of patients.Therefore,in order to improve the quality of life of patients,it is very necessary to study the influencing factors of tracheal decannulation after partial laryngectomy and take corresponding preventive measures in turn.Objectiv : To explore the influencing factors of tracheal decannulation after partial laryngectomy.Methods:By consulting the medical record system of the whole hospital of the affiliated hospital of Ningxia Medical University,we selected cases with complete clinical data and confirmed that the study object was 135 laryngeal cancer patients who had undergone partial laryngectomy in our department from October 2011 to October 2021.By using the method of retrospective analysis,we divided them into extubated group and non-extubated group according to whether they were extubated before discharge from our department,and recorded the general information of patients: age,sex Smoking history(specific to year and branch/day),preoperative and postoperative hemoglobin value,preoperative and postoperative albumin value,tumor site,surgical method,whether arytenoid cartilage is removed,who is operated,whether neck dissection is performed,operation time(hours),TNM stage,postoperative complications,hospital days,whether radiotherapy,whether swallowing dysfunction,whether chronic obstructive pulmonary disease,whether gastric ulcer or reflux esophagitis For the retention time of nasal feeding tube and endotracheal tube,SPSS 20.0 statistical software was used to carry out single factor analysis on the data of the above influencing factors,and the relevant factors with statistical significance were included in the multivariate logistic regression analysis.The results showed that P<0.05 was statistically significant.Results: Of the 135 male patients,63 were able to extubate before discharge,and 72 were delayed in decannulation.The average decannulation time in the delayed decannulation group was 98(23-330)days.Univariate analysis: There were significant differences between the decannulation group and the non-decannulation group in the time of removal of the nasogastric feeding tube,nutritional status,whether there was gastric ulcer or reflux esophagitis,T stage,N stage,tumor site,operation type,whether arytenoidectomy was performed,pathology,postoperative complications,postoperative radiotherapy,and whether there was postoperative swallowing(P<0.05).There was no significant difference between the two groups in age,smoking index,operator,chronic obstructive pulmonary disease and neck clearance(P>0.05).Multivariate logistic regression analysis: the effect of gastric ulcer or reflux esophagitis on the decannulation time was statistically significant(OR=6.693,95%CI 1.732-25.854,P<0.05);The effect of arytenoidectomy on decannulation time was statistically significant(OR=72.656,95%CI 11.067-476.984,P<0.000);The effect of early postoperative complications on decannulation time was statistically significant(OR=6.483,95%CI 1.676-25.082,P<0.05);The influence of postoperative swallowing errors on decannulation time was statistically significant(OR=5.246,95%CI 1.459-18.863,P<0.05);Compared with VPL,SCPL increased the risk of delayed decannulation,and the difference was statistically significant(OR=8.722,95%CI 2.103-36.176,P<0.05);Compared with well-differentiated squamous cell carcinoma,poorly differentiated squamous cell carcinoma increased the risk of delayed decannulation,and the difference was statistically significant(OR=11.349,95%CI 1.858-69.318,P<0.05);Compared with T1,T3 increased the risk of delayed decannulation(OR=6.750,95%CI 1.214-37.525,P<0.05);The nutritional status and tumor site had no effect on the occurrence of delayed decannulation(P>0.05).Conclusion:1.The factors that affect the time of tracheal cannula decannulation in laryngeal cancer patients are diverse and interrelated.Age,concomitant gastric ulcer or reflux esophagitis,surgical procedure,T-stage,pathological type,unilateral arytenoidectomy,postoperative complications,and postoperative aspiration are risk factors for delayed decannulation.2.Misswallowing may be an important factor affecting decannulation,so identifying potential patients with paraphagia early in the perioperative period and early intervention can reduce the time of tracheal cannula insertion and improve the postoperative quality of life of patients. |
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