Analysis Of Related Factors To Pharyngeal Fistula After Laryngeal Cancer Surgery

Objective：To explore the risky factors of pharyngeal fistula after Laryngeal cancersurgery.Methods: To retrospectively analyze that clinical data of132patients from firstAffiliated Hospital of Dalian Medical University, and20cases concurrent pharyngealfistula.To sort these data and analyze the relationship between Pharyngeal fistula andthe factors such as sex,age,Smoking,with diabetes,preoperative hemoglobin,tumortypes,clinical stage of tumor,preoperative radiotherapy,preoperative tracheotomy,themethod of operation,simultaneous neck dissection，intraoperative blood-transfusion,time of operation,nasal feeding time， and post-operative infection， applicateSingle-factor analysis with chi-square test for statistical analysis． To find out theinfluence factors of Pharyngeal fistula after laryngeal cancer surgery.Result:we have completed132cases of laryngeal cancer surgery During the fiveyears.Among the20patients with pharyngeal fistula after laryngectomy，the totalincidence rate was about15.2%， the earliest time of Pharyngeal fistula occurred was4days after the surgery,and at the latest was18days after the surgery, an average of9.1day.The patients’ages from50to75years old,and an average of62.2years old.Theincidence of pharyngeal fistula in patients who less than60years old was11.3%(7/62)；But the incidence of pharyngeal fistula in patients who more than60years oldwas18.6%（13/70）. The incidence of pharyngeal fistula was15.6%（19/122） in malepatients, and10﹪（1/10）in female patients.The incidence of pharyngeal fistula inpatients with smoking was15.3%(13/85);The incidence of pharyngeal fistula in the restof patients was14.9%（7/47）.For preoperative hemoglobin，the incidence rate ofpharyngeal fistula within group of <125g/L and≥125g/L was respectively20.0﹪（8/40）、13.4﹪（12/92）.The incidence rate of pharyngeal fistula with totallaryngectomy was21.8﹪（12/55）,The incidence rate of pharyngeal fistula withpartial laryngectomy was10.4﹪（8/77）.The incidence rate of pharyngeal fistulawith intraoperative blood-transfusion was21.4﹪（9/42）；The incidence rate ofpharyngeal fistula without intraoperative blood-transfusion was12.2﹪（11/90）.Theincidence rate of pharyngeal fistula in the patients that operation time is less than6hours was12.8﹪（11/86）,The incidence rate of pharyngeal fistula in the patients thatoperation time is more than6hours was19.6﹪（9/46）.According to the result ofstatistical analysis by Single-factor analysis with chi-square test, the differences withinthese factors have not been statistically significant（χ2value were1.356、0.223、0.004、1.049、3.260、1.888、1.070respectively，P＞0.05）.The incidence rate of pharyngeal fistula in the patients with diabetes was33.3%（8/24）,The incidence rate of pharyngeal fistula in the patients without diabetes was11.1﹪（12/108）.Among clinical stage of tumor（Ⅰ+Ⅱ）,the incidence rate ofpharyngeal fistula for patients of early stage was9.41%（8/85）.Whereas，for patientsof late stage （Ⅲ+Ⅳ）was25.5%（12/47）。Among tumor types,the incidence rate ofpharyngeal fistula for patients of supraglottic carcinoma, glottic carcinoma, subglotticcarcinoma and transglottic carcinoma was respectively31.3﹪（10/32）、7.8﹪（6/77）、18.2﹪（2/11）、16.7﹪（2/12）.The incidence rate of pharyngeal fistula in patients whohad received radiotherapy before operation was29.6﹪（8/27）; The incidence rate ofpharyngeal fistula in patients who had not received radiotherapy before operation was11.4﹪（12/105）.The incidence rate of pharyngeal fistula in patients who had acceptedpreoperative tracheotomy was27.3﹪（9/33）,The incidence rate of pharyngeal fistulain patients who had not accepted preoperative tracheotomy was11.1﹪（11/99）. Theincidence rate of pharyngeal fistula in patients who had underwent simultaneous neckdissection was25.7﹪（9/35）;The incidence rate of pharyngeal fistula in patients whohad not underwent simultaneous neck dissection was11.3﹪（11/97）.The incidence rateof pharyngeal fistula in patients who had happened post-operative infection was29.6﹪（8/27）;The incidence rate of pharyngeal fistula in patients who had not happenedpost-operative infection was11.4﹪（12/105）.The incidence rate of pharyngeal fistula inpatients whose nasal feeding time less than10days was34.8%（8/23）;The incidencerate of pharyngeal fistula in patients whose nasal feeding time between10to15dayswas10.1﹪（9/89）;The incidence rate of pharyngeal fistula in patients whose nasalfeeding time more than15days was15.0﹪（3/20）.According to the result of statisticalanalysis by Single-factor analysis with chi-square test, the differences within thesefactors have been statistically significan（t χ2value were5.913、6.118、9.795、4.209、5.029、4.134、4.209、8.653，，P＜0.05）.Conclusion:we found that the risky factors for postoperative pharyngeal fistulainclude diabetes,tumor types,clinical stage of tumor,preoperativeradiotherapy,preoperative tracheotomy,simultaneous neck dissection，nasal feeding timeand post-operative infection.