Predisposing Factors,Prophylaxis And Treatment Of Pharyngocutaneous Fistula After Surgery Of Laryngeal Carcinoma And Hypopharyngeal Carcinoma

Objective: To explore the predisposing factors,prophylaxis and treatment of pharyngocutaneous fistula after surgery of laryngeal carcinoma and hypopharyngeal carcinoma.Methods: Complete medical records of 148 patients undergoing total laryngectomy for laryngeal carcinoma or surgery for hypopharyngeal carcinoma from January 2015 to November 2019 at Department of Otolaryngology,First Affiliated Hospital of Fujian Medical University were collected.Washing tubes and drainage tubes were placed on all patients intraoperatively.Possible risk factors of pharyngocutaneous fistula include age,sex,smoking history,alcohol consumption,tumor type,the T and N staging of tumor,tumor differentiation,the method used for reconstruction,combination with neck dissection,previous radiotherapy,underlying systemic disease,preoperative tracheotomy,preoperative albumin level,postoperative albumin level,postoperative hemoglobin level,perioperative blood transfusion,which were retrospectively studied.Results: Among all 148 patients,pharyngocutaneous fistula occurred in 19 cases(28.3%)of laryngeal carcinoma and 21(25.9%)of hypopharyngeal carcinoma,totaling 40(27%).Statistical analysis revealed that preoperative tracheotomy and reconstruction with flap were independent risk factors of pharyngocutaneous fistula.Previous radiotherapy is a possible risk factor.No significant relation was noted between pharyngocutaneous fistula and age,gender,smoking,alcohol consumption,tumor type,the T and N staging of tumor,tumor differentiation,neck dissection,systemic diseases,preoperative albumin level,postoperative albumin level,postoperative hemoglobin level or perioperative blood transfusion.The average postoperative hospital stays of patients with pharyngeal fistula were 26.5(22 ～ 35.5)days,which were significantly more than that of patients without fistula,14(13 ～ 16)days.Among 40 cases of fistula,36 were repaired successfully by washing and dressing,and 1 case cured by local debridement and suture after conservative treatment.One patient took conservative treatment and a tiny fistula orifice remained,posing no risks of infection and rupture of vessels and not interfering with daily life.Two patients lost to follow up.Conclusions:(1)Preoperative tracheotomy and reconstruction with flap are independent risk factors of pharyngocutaneous fistula in patients after surgery for laryngeal carcinoma and hypopharyngeal carcinoma.Previous radiotherapy is a possible risk factor.(2)The preset washing tube and drainage tube help in timely diagnosis of postoperative pharyngeal fistula,and effectively reduces the harm of pharyngeal fistula.Most patients could be cured by washing and dressing.