Prophylaxis And Treatment Of Pharyngo-cutaneous Fistula After Surgery For Larynx And Hypopharynx Cancer

Purpose:To explore the etiology, mechanism and prevention measures through analysis of the main cause of Pharyngo-cutaneous fistula after surgery of laryngeal carcinoma and hypopharyngeal carcinoma.Methods:Collecting complete medical records of 198 patients with laryngeal carcinoma and hypopharyngeal carcinoma (including 187 cases of laryngeal carcinoma and 11 of hypopharyngeal carcinoma) from 2009 to 2011 at Department of Otolaryngology, first Affiliated Hospital of Zhengzhou University and analyzing statistically by using of SPSS10.0.Results:Among the 187 cases of laryngeal carcinoma,18 cases (9.6%) were Pharyngo-cutaneous fistula after operation and 3 in 11 cases (27.3%) of hypopharyngeal carcinoma. Except of the only 1 cases of spindle cells of soft tissue sarcomas, the rest of 197 are larynx (or swallow) squamous cell carcinoma. According to the statistical analysis results, the predominant influencing factors in the causation of Pharyngo-cutaneous fistula are tumor stage and operation method. Meanwhile, whether patients have merger diabetes, preoperative radiation, lower hemoglobin level, tracheotomy and lymph node dissection before survey as well as the temperature is over 37.5 degrees after survey do affect the results. It doesn't have any statistical significance about the patient's age, gender, tumor growth parts and operation time. Data shows that patients who have lower hemoglobin level, merger diabetes, preoperative radiation, tracheotomy and lymph node dissection before survey and got temperature over 37.5 degrees after survey risk greater complication than those without the treatment.Conclusion:High-risk factors for Pharyngo-cutaneous fistula following main points:1, lower preoperative hemoglobin level; 2, revealed diabetes mellitus; 3, Previous radiotherapy; 4, prior tracheotomy; 5, tumor stageⅢ～Ⅳ; 6, total laryngectomy 7, lymph node dissection; 8, temperature over 37.5 degrees within 48h.For these patients, we must determine preoperative nutritional status will be adjusted to the best of them; strictly control surgical indications; postoperative intensive care. Only in this way, it is possible reduce the occurrence of Pharyngo-cutaneous fistula, reduce the burden on patients.