喉頭全摘術後の咽頭皮膚瘻

Pharyngocutaneous Fistula after Total Laryngectomy

　はじめに

　喉頭全摘術後の咽頭皮膚瘻の発生は，経口摂取の遅延や入院期間の延長の原因となり，また総頸動脈破裂を起こし得る危険な合併症である。患者のQOLを著しく低下させるため，頭頸部外科医にとっては回避すべき合併症の1つである。咽頭皮膚瘻の発生要因については，これまでに諸外国ではいくつかの報告^1〜11）があるが，本邦における報告^12〜14）は数少ない。

　今回，当科において喉頭悪性腫瘍の診断で喉頭全摘術を施行した症例を対象に，咽頭皮膚瘻の発生頻度，要因について検討したので報告する。

In our department, 78 patients had total laryngectomy for malignant tumors from 1981 through 2000.

The age of patients, the dose of preoperative radia-tion, the period from radiotherapy to salvage operation, the suture material used for the closure of the pharynx,and the radical neck dissection were discussed for pha-ryngocutaneous fistula formation.

Pharyngocutaneous fistula were observed in 13 out of 78 patients (15.3%)

Fistula incidence tended to increase with the follow-ing factors : age of≧60 years, radiation doses of≧60 Gy, period to salvage operation of≧_6 months, use of cat-gut and with bilateral neck dissection.

A statistically significant difference was only seen between patients treated with radiation with 40 Gy or less and those treated with radiation with 60 Gy or more.