The Etiology,prevention And Therapy Of Postlaryngectomy Pharyngeal Fistula

Objective:To explore the predisposing factors, the management of the postlaryngectomy pharyngeal fistula, and how to prevent them in our clinic.Methods:The medical records of114patients who underwent total laryngeal surgery between2000and2011were assessed. We studied a number of factors that could influence fistula formation such as age、preoperative radiotherapy、neck dissection、somking、diabetes mellitus、site of tumor and TNM grade/stage.Results:12patients resulted in pharyngeal fistula (10.5%). Patients with a surgical closure was necessary in7.6patients required surgical closure by direct suture of the pharyngeal mucosa. Pectoralis major myocutaneous flap was used in another one. Spontaneous closure with local wound care was noted in5.Conclusion:There are many conflicting reports in the literature concerning the predisposing factors, our data showed that Hb value of pre-operation, Diabetes Mellitus, site of tumor, T、N grade of tumor and stage of tumor are closely related with pharyngeal fistula. Our experience confirmed that most fistulae can be successfully managed with conservative treatment and surgical direct closure. A small number of the patients with pharyngeal fistula needed myocutaneous flap repair.