当科における喉頭全摘術後の合併症の検討

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Introduction: We examined post-total laryngectomy complications. By using PGE1 during the perioperative period, we made it possible to achieve complication-free laryngeal surgery for patients with radiation failure. We now present our evaluation of complication frequencies of patients with radiation failure and those without it.Patients and Methods: Our work was a retrospective chart review of 37 patients who underwent total laryngectomy in our hospital from 2001 to 2008. These included 24 patients who underwent surgery for primary treatment and 12 patients who underwent salvage surgery due to radiation failure. The remaining one patient had laryngo-pharyngeal stenosis after radiation therapy for hypopharyngeal cancer and underwent total laryngectomy as a salvage surgery. One T2, 9 T3 and 14 T4 cases underwent surgery for primary treatment and 2 T2, 5 T3 and 5 T4 cases underwent salvage surgery. Closure of the hypopharyngeal mucosa was performed using 4-0 silk and no other procedures were conducted to reinforce the wound.Results: As for 24 patients who underwent primary treatment, a minor leakage and a pharyngo-cutaneous fistula were observed in two patients who had active diabetes mellitus and their initiation of oral intake were on the 17th post-operative day (POD) and the 34th POD, respectively. Their days of discharge were also prolonged to the 30th POD and the 50th POD, respectively. One patient had a subcutaneous abscess around his tracheostoma and the commencement of his oral intake and day of discharge were prolonged to the 13th POD and the 28th POD. Another patient also had a subcutaneous abscess and his day of discharge was prolonged to the 36th POD. The average number of days to begin oral intake after surgery was 9.1 days and the average number of days until discharge after surgery were 23.3 days. However, with 13 patients who underwent salvage surgery and had no leakage or other wound complications the average number of days to discharge after surgery was 20.8 days.Discussion: According to our protocols for laryngectomies, the administration of PGE1 during the perioperative period, even for patients with radiation failure that had no wound complication, shortened the time to discharge from the hospital. Since diabetes mellitus seemed to be a key factor in wound complication after laryngectomies, even for patients undergoing primary treatment, we must consider new methods for treating them.

当科における喉頭全摘術後の合併症の検討

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