头颈部术后术区彩色超声检查的临床价值探讨
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摘要
目的:本研究通过对头颈部肿瘤患者术后颈部术区超声检查了解有无积液存在,协助临床诊治,早期发现并发症,减少危害。
方法:分析34例头颈肿瘤患者术后术区彩色超声检查情况,并将其分为积液组与非积液组。分析病种手术类型、肿瘤分期、合并糖尿病患者、手术时长、颈淋巴结清扫术与肌皮瓣转移修复术、术后引流管放置时长及术后超声检查时间与积液的相关性,探讨积液对患者术后住院时间及咽瘘的影响价值。
结果:咽腔开放手术与喉腔开放手术患者比较术后颈部积液的发生率有统计学差异(P<0.05)。患者肿瘤分期、颈淋巴结清扫、肌皮瓣转移修复、手术时长、引流管放置时间及术后行超声检查时间在两组中差异无统计学意义(P>0.05)。合并糖尿病患者在术后积液及咽瘘的发生率中有统计学差异(P<0.05)。两组患者咽瘘发生率及术后住院时间差异有统计学意义(P<0.05)。
结论:行咽腔开放手术肿瘤切除患者术区积液的发生率比喉腔开放性手术患者大;合并糖尿病的头颈部肿瘤患者术后颈部易积液同时并发咽漏的机会大;头颈部肿瘤术后拔除引流管后超声检查提示有积液的患者术后住院时间可能会延长同时发生咽瘘的风险高;头颈部肿瘤术后术区彩色超声检查是安全、有效的,能快速了解术区积液情况,协助临床诊治。
Objectve In order to prvent postoperative complications, evaluation of postoperative ultrasonic inspection on effusion in surgical region after head and neck surgeries was performed.
Methods 34 surgical cases with head and neck cancer were divided into effusion group and non- effusion group based on the results of postoperative ultrasonography. Rates of effusion was studied according to the following potential predictors: surgery performed, tumor stage, patients with diabetes mellitus, duration of surgery, neck dissection,muscle flap repairation, duration of postoperative drainage and the time of postoperative ultrasonograhy . In addition, the effusion influences on postoperative hospital stay and pharyngeal fistula are also discussed.
Results There was statistically significance in the incidence of postoperative effusion beteeen the surgeries of pharyngeal cavity opening and laryngeal cavity opening(P<0.05). No statistical significancant influecnces on effucion were found concerning the factors of tumor stage, neck dissection , myocutaneous flap repairation, duration of sugery, duration of postoperative drainage and the time of postoperative ultrasonograhy(P>0.05). Diabetes acted as a significant factor in postoperative effusion and pharyngeal fistula (P<0.05). Postoperative effusion significantly increased the rate of pharyngeal fistula and the duration of postoperative hospital stay.
Conclusion Patients with a pharyngeal cavity opening surgery showed a higher incidence of postoperative effusion than the others who had surgeries of laryngeal cavity; Patients with diabetes may have a higher opportunity of postoperative effusion and pharyngeal fistula; Patients who were foud effusion in the postoperative region by ultrasonograhy after removing drainage tube will have a longer hospital stay as well as higher risk of pharyngeal fistula. Color ultrasonography used in the postoperative region of head and neck is a safe and effective examination in diagnosis and management of postoperative effusion.
方法:分析34例头颈肿瘤患者术后术区彩色超声检查情况,并将其分为积液组与非积液组。分析病种手术类型、肿瘤分期、合并糖尿病患者、手术时长、颈淋巴结清扫术与肌皮瓣转移修复术、术后引流管放置时长及术后超声检查时间与积液的相关性,探讨积液对患者术后住院时间及咽瘘的影响价值。
结果:咽腔开放手术与喉腔开放手术患者比较术后颈部积液的发生率有统计学差异(P<0.05)。患者肿瘤分期、颈淋巴结清扫、肌皮瓣转移修复、手术时长、引流管放置时间及术后行超声检查时间在两组中差异无统计学意义(P>0.05)。合并糖尿病患者在术后积液及咽瘘的发生率中有统计学差异(P<0.05)。两组患者咽瘘发生率及术后住院时间差异有统计学意义(P<0.05)。
结论:行咽腔开放手术肿瘤切除患者术区积液的发生率比喉腔开放性手术患者大;合并糖尿病的头颈部肿瘤患者术后颈部易积液同时并发咽漏的机会大;头颈部肿瘤术后拔除引流管后超声检查提示有积液的患者术后住院时间可能会延长同时发生咽瘘的风险高;头颈部肿瘤术后术区彩色超声检查是安全、有效的,能快速了解术区积液情况,协助临床诊治。
Objectve In order to prvent postoperative complications, evaluation of postoperative ultrasonic inspection on effusion in surgical region after head and neck surgeries was performed.
Methods 34 surgical cases with head and neck cancer were divided into effusion group and non- effusion group based on the results of postoperative ultrasonography. Rates of effusion was studied according to the following potential predictors: surgery performed, tumor stage, patients with diabetes mellitus, duration of surgery, neck dissection,muscle flap repairation, duration of postoperative drainage and the time of postoperative ultrasonograhy . In addition, the effusion influences on postoperative hospital stay and pharyngeal fistula are also discussed.
Results There was statistically significance in the incidence of postoperative effusion beteeen the surgeries of pharyngeal cavity opening and laryngeal cavity opening(P<0.05). No statistical significancant influecnces on effucion were found concerning the factors of tumor stage, neck dissection , myocutaneous flap repairation, duration of sugery, duration of postoperative drainage and the time of postoperative ultrasonograhy(P>0.05). Diabetes acted as a significant factor in postoperative effusion and pharyngeal fistula (P<0.05). Postoperative effusion significantly increased the rate of pharyngeal fistula and the duration of postoperative hospital stay.
Conclusion Patients with a pharyngeal cavity opening surgery showed a higher incidence of postoperative effusion than the others who had surgeries of laryngeal cavity; Patients with diabetes may have a higher opportunity of postoperative effusion and pharyngeal fistula; Patients who were foud effusion in the postoperative region by ultrasonograhy after removing drainage tube will have a longer hospital stay as well as higher risk of pharyngeal fistula. Color ultrasonography used in the postoperative region of head and neck is a safe and effective examination in diagnosis and management of postoperative effusion.
引文
1明伟,华清泉,詹汉章.晚期喉咽癌和喉癌全喉切除术后咽皮肤瘘[J].临床耳鼻咽喉头颈外科杂志,2008,22(12):542.
2白丹,陈阳,查定军,等.咽瘘的产生及防治现状探讨[J].临床耳鼻咽喉科头颈外科杂志,2009,23(03):141-144.
3戴朴,杨仕明,张延平,等.喉切除术后咽瘘的预防和治疗[J].中国耳鼻咽喉头颈外科,2004,11(4):205-207.
4李治安主编.临床超声影像学[M].北京:人民卫生出版社,2003.11.1759.
5夏稻子主编.超声诊断学[M].北京:人民卫生出版社,2008.8,10.
6张缙熙主编.浅表器官及组织超声诊断学[M].北京:科学技术文献出版社,2000.8.184-185.
7徐秋华陆林国主编.上海:浅表器官超声诊断图鉴[M].上海科学技术出版社,2005.1.57.
8孙威郝艳香王欣.超声成像的诊断基础[J].中国实验诊断学,1999,3(5):249.
9张平主编.浅表器官疾病超声诊断[M].成都:四川大学出版社,2005.10.96-100.
10韦正波,谢莹,许坚,等.喉全切除术后咽瘘影响因素的Meta分析[J].中国耳鼻咽喉头颈外科,2007,14(10):563-566.
11 Paolo Boscolo-Rizzo Giuseppe De Cillis ,Carlo Marchiori Silvia Carpenè,Maria Cristina Da Mosto.Multivariate analysis of risk factors for pharyngocutaneous fistula after total laryngectomy[J].Eur Arch Otorhinolaryngol,2008,265:929–936.
12张彬,唐平章,徐震纲,等.下咽环周缺损重建方法的选择[J].中华耳鼻咽喉科杂志,2004,39(7):419—423.
13黄建民,栾信庸,潘新良,等.梨状窝内侧壁癌切除与喉功能保留[J].中华耳鼻咽喉科杂志,2001,36(4)254-257.
14 Tai SK,Chang SY.Hemilaryngotracheal flap reconstruction of the hypopharynx in pyriform carcinoma resection[J].Laryngoscope,1999,109(3):221-225.
15 Birkmeyer,Nancy J,Joseph A,Paydarfar.Complications in Head and Neck Surgery:A Meta-analysis of Postlaryngectomy Pharyngocutaneous Fistula[J].Archives of Otolaryngology-Head and Neck surgery,2006,132(1):67-72.
16 Makitie A, Irish J, Gullane P.Pharyngocutaneous fistula[J].Curr Opin Otolaryngol Head Neck Surgery, 2003,11:78–84.
17 Galli J , De-Corso E , Volante M , et al . Postlaryngectomy pharyngocutaneous fistula:incidence,predisposing factors,and therapy[J].Otolaryngol Head Neck Surgery,2005,133:689-694.
18 Makitie AA, Niemensivu R, Hero M, et al. Pharyngocutaneous fistula following total laryngectomy: a single institution’s
10-year experience[J]. Eur Arch Otorhinolaryngol,2006,263:1127–1130.
19 Markou KD, Vlachtsis KC, Nikolaou AC, Petridis DG, Kouloulas AI, Daniilidis IC. Incidence and predisposing factors of pharyngocutaneous fistula formation after total laryngectomy. Is there a relationship with tumor recurrence?[J] Eur Arch Otorhinolaryngol,2004,261:61–67.
20 Cavalot AL, Gervasio CF, Nazionale G, Albera R, Bussi M, StaYeri A, Ferrero V, Cortesina G. Pharyngocutaneous fistula as a complication of total laryngectomy: review of the literature,analysis of case records[J]. Otolaryngol Head Neck Surgery,2000,123:587–592.
21 Jovanovic M, Perovic J, Grubor A.The impact of diabetes mellitus on postoperative morbidity in laryngeal surgery[J]. Acta Chir Iugosl,2006, 53:51–55.
22 Urken ML, Weinburg H, Buchbinder D, et al. Microvascular free flaps in head and neck reconstruction: report of 200 cases and review of complications[J].Arch Otolaryngol Head Neck Surg,1994; 120:633– 640.
23 Lambiase RE. Percutaneous abscessand fluid drainage: a critical review[J].Cardiovasc Intervent Radiol, 1991,14:143–157.
24 Mohammed JA, Warnke PH, Stavraky W. Ultrasound in the diagnosis and managementof fluid collection complications following abdominoplasty[J].Ann Plast Surgery,1998,41:498–502.
25 Kee-Min Yeow,Chun-Ta Liao,Pei-Kwei Tsay,et al.US-guided Catheter Drainage of Postoperative Head and Neck Fluid Collections[J].Journal of Vascular and Interventional Radiology,2003,14(5):589-595.
26 Shamley DR,Barker K,Simonite V,et a1.Delayed versus immediate exercises following surgery for breast cancer:a systematic review [J].Breast Cancer Res Treat,2005,90(3):263.
27王家泰,张青海,周庆,等.颈部食管胃吻合口瘘的防治体会[J].中国医师杂志,2006,8(2):213.
28赵月云.持续负压引流对食管癌术后颈部切口感染的影响研究[J].国际护理学杂志,2010,29(4):634-635.
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31 Friedman M, Venkatesan TK, Yakovlev A, Lim JW, Tanyeri HM, Caldarelli DD.Early detection and treatment of postoperative pharyngocutaneous fistula[J]. Otolaryngol Head and Neck Surgery,1999, 121:378–380.
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33 Morton RP,Mehanna HM,Hall FT,et al.Prediction of pharyngocutaneous fistulas after Laryngectony[J].Otolaryngol Head Neck Surg,2007,136(4):546-549.
34 Bello TO,Taiwo SS,Oparinde DP,et al.Risk of nosocomial bacteria transmission;evavuation of cleaning methods of probes used for routine ultrasonography.West Afr J Med,2005,24;167-170.
35超声探头微生物污染流行病学调查及控制对策[J].中国基层医药,2007,14(7):1137-1139.
1白丹,陈阳,查定军,等.咽瘘的产生及防治现状探讨[J].临床耳鼻咽喉科头颈外科杂志,2009,23(03):141-144.
2戴朴,杨仕明,张延平,等.喉切除术后咽瘘的预防和治疗[J].中国耳鼻咽喉头颈外科,2004,11(4):205-207.
3杨丽辉,郭星,等.喉切除术后咽瘘发生的相关因素[J].中国耳鼻咽喉头颈外科.2006,(05):277-280.
4 Birkmeyer,Nancy J,Joseph A,Paydarfar.Complications in Head and Neck Surgery:A Meta-analysis of Postlaryngectomy Pharyngocutaneous Fistula[J].Archives of Otolaryngology-Head and Neck surgery,2006,132(1):67-72.
5 Paolo Boscolo-Rizzo Giuseppe De Cillis ,Carlo Marchiori Silvia Carpenè,Maria Cristina Da Mosto.Multivariate analysis of risk factors for pharyngocutaneous fistula after total laryngectomy[J].Eur Arch Otorhinolaryngol,2008,265:929–936.
6 Galli J , De-Corso E , Volante M , et al . Postlaryngectomy pharyngocutaneous fistula:incidence,predisposing factors,and therapy[J].Otolaryngol Head Neck Surgery,2005,133:689-694.
7 Makitie AA, Niemensivu R, Hero M, Keski-Santti H, Back L, KajantiM, Lehtonen H, Atula T . Pharyngocutaneous fistula following total laryngectomy: a single institution’s 10-year experience[J]. Eur Arch Otorhinolaryngol,2006,263:1127–1130.
8 Markou KD, Vlachtsis KC, Nikolaou AC, Petridis DG, Kouloulas AI, Daniilidis IC. Incidence and predisposing factors of pharyngocutaneous fistula formation after total laryngectomy. Is there a relationship with tumor recurrence?[J] Eur Arch Otorhinolaryngol,2004,261:61–67.
9 Cavalot AL, Gervasio CF, Nazionale G, Albera R, Bussi M, StaYeri A, Ferrero V, Cortesina G. Pharyngocutaneous fistula as a complication of total laryngectomy: review of the literature,analysis of case records[J]. Otolaryngol Head Neck Surgery,2000,123:587–592.
10 Jovanovic M, Perovic J, Grubor A.The impact of diabetes mellitus on postoperative morbidity in laryngeal surgery[J]. Acta Chir Iugosl,2006, 53:51–55.
11宋斌,陈伊宁.喉癌术后咽瘘的预防及处理[J].耳鼻喉-头颈外科杂志,2003,10(4):251-252.
12韦正波,谢莹,许坚,等.喉全切除术后咽瘘影响因素的Meta分析[J].中国耳鼻咽喉头颈外科,2007,14(10):563-566.
13 Hier M,Black MJ,Lafond G.Pharyngocutaneous fistulas after total Laryngectomy:incidence,etionlogy and outcome analysis[J].Otoaryngol,1993,22:164-166.
14 Hall FT,Obrien CJ,Clifford AR,et al.Clinical outcome following total Laryngectomy forcancer[J].ANZ J Surgery,2003,73:300-305.
15包亚军,刘永义,等.喉癌术后咽瘘12例分析[J].中国误诊学杂志,2008,8(12):2988-2989.
16明伟,华清泉,詹汉章.晚期喉咽癌和喉癌全喉切除术后咽皮肤瘘[J].临床耳鼻咽喉头颈外科杂志.2008,22(12):542.
17 Tai SK,Chang SY.Hemilaryngotracheal flap reconstruction of the hypopharynx in pyriform carcinoma resection[J].Laryngoscope,1999,109(3):221-225.
18 Makitie A, Irish J, Gullane P.Pharyngocutaneous fistula[J].Curr Opin Otolaryngol Head Neck Surgery, 2003,11:78–84.
19唐平章,祁永发,屠规益,等.胸大肌肌皮瓣的适应症及并发症一379例次经验总结[J].耳鼻咽喉头颈外科,1994,1(1):44—47.
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23 Schwartz SR, Yueh B, Maynard C, Daley J, Henderson W.Predictors of wound complications after laryngectomy: astudy of over 2000 patients[J]. Otolaryngol Head Neck Surg,2004;134:61–68.
24 Morton RP,Mehanna HM,Hall FT,et al.Prediction of pharyngocutaneous fistulas after Laryngectony[J].Otolaryngol Head Neck Surg,2007,136(4):546-549.
25姚行齐,杨长亮,孙艺.喉癌术后咽瘘相关因素分析及处理[J].华南国防医学杂志,2009,23(5):84-85.
26吕威,倪道凤.全喉切除术后咽瘘病因探讨[J].临床耳鼻咽喉科杂志,2001,3:106-109.
27 Ian Ganly, Snehal Patel, Jeanette Matsuo,et al. Postoperative Complications of Salvage Total Laryngectomy[J]. Wiley InterScience,2005,103(10):2073-2080.
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29王晋.喉癌术后咽瘘的原因分析及处理[J].新疆医学,2009,39(1):91-95.
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31张珉,吴新尚,赵瑞.预防喉切除术后咽瘘的体会[J].中国耳鼻咽喉颅底外科杂志,2009,3:228-229.
32 Friedman M, Venkatesan TK, Yakovlev A, Lim JW, Tanyeri HM, Caldarelli DD.Early detection and treatment of postoperative pharyngocutaneous fistula[J]. Otolaryngol Head and Neck Surgery,1999, 121:378–380.
33 Shamley DR,Barker K,Simonite V,et a1.Delayed versus immediate exercises following surgery for breast cancer:a systematic review [J].Breast Cancer Res Treat,2005,90(3):263.
34李治安主编.临床超声影像学[M].北京:人民卫生出版社,2003.11.1759.
35张平主编.浅表器官疾病超声诊断[M].成都:四川大学出版社,2005.10.96-100.
36 Lambiase RE. Percutaneous abscessand fluid drainage: a critical review[J].Cardiovasc Intervent Radiol, 1991,14:143–157.
37赵月云.持续负压引流对食管癌术后颈部切口感染的影响研究[J].国际护理学杂志,2010,29(4):634-635.
38 Yeow KM, Liao CT, Hao SP. US guided needle aspiration and catheter drainage as an alternative to open surgical drainage for uniloculated neck abscesses[J]. J Vasc Interv Radiol 2001;5:589–594.
39张惠芹温咏珊郑美春。壁式中心负压吸引处理头颈部术后口底瘘、舌下瘘的观察[J].当代医学,2009,15(33):65-66.
40 Kee-Min Yeow,Chun-Ta Liao,Pei-Kwei Tsay,et al.US-guided Catheter Drainage of Postoperative Head and Neck Fluid Collections[J].Journal of Vascular and Interventional Radiology,2003,14(5):589-595
41 Bello TO,Taiwo SS,Oparinde DP,et al.Risk of nosocomial bacteria transmission;evavuation of cleaning methods of probes used for routine ultrasonography.West Afr J Med,2005,24;167-170.
42 Mohammed JA, Warnke PH, Stavraky W. Ultrasound in the diagnosis and managementof fluid collection complications following abdominoplasty[J].Ann Plast Surgery,1998,41:498–502.
2白丹,陈阳,查定军,等.咽瘘的产生及防治现状探讨[J].临床耳鼻咽喉科头颈外科杂志,2009,23(03):141-144.
3戴朴,杨仕明,张延平,等.喉切除术后咽瘘的预防和治疗[J].中国耳鼻咽喉头颈外科,2004,11(4):205-207.
4李治安主编.临床超声影像学[M].北京:人民卫生出版社,2003.11.1759.
5夏稻子主编.超声诊断学[M].北京:人民卫生出版社,2008.8,10.
6张缙熙主编.浅表器官及组织超声诊断学[M].北京:科学技术文献出版社,2000.8.184-185.
7徐秋华陆林国主编.上海:浅表器官超声诊断图鉴[M].上海科学技术出版社,2005.1.57.
8孙威郝艳香王欣.超声成像的诊断基础[J].中国实验诊断学,1999,3(5):249.
9张平主编.浅表器官疾病超声诊断[M].成都:四川大学出版社,2005.10.96-100.
10韦正波,谢莹,许坚,等.喉全切除术后咽瘘影响因素的Meta分析[J].中国耳鼻咽喉头颈外科,2007,14(10):563-566.
11 Paolo Boscolo-Rizzo Giuseppe De Cillis ,Carlo Marchiori Silvia Carpenè,Maria Cristina Da Mosto.Multivariate analysis of risk factors for pharyngocutaneous fistula after total laryngectomy[J].Eur Arch Otorhinolaryngol,2008,265:929–936.
12张彬,唐平章,徐震纲,等.下咽环周缺损重建方法的选择[J].中华耳鼻咽喉科杂志,2004,39(7):419—423.
13黄建民,栾信庸,潘新良,等.梨状窝内侧壁癌切除与喉功能保留[J].中华耳鼻咽喉科杂志,2001,36(4)254-257.
14 Tai SK,Chang SY.Hemilaryngotracheal flap reconstruction of the hypopharynx in pyriform carcinoma resection[J].Laryngoscope,1999,109(3):221-225.
15 Birkmeyer,Nancy J,Joseph A,Paydarfar.Complications in Head and Neck Surgery:A Meta-analysis of Postlaryngectomy Pharyngocutaneous Fistula[J].Archives of Otolaryngology-Head and Neck surgery,2006,132(1):67-72.
16 Makitie A, Irish J, Gullane P.Pharyngocutaneous fistula[J].Curr Opin Otolaryngol Head Neck Surgery, 2003,11:78–84.
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