摘要目的 从咽瘘发生率、住院天数方面探讨喉全切术后早期经口进食的安全性及可行性.方法 回顾性分析2012年1月至2017年10月在北京协和医学院肿瘤医院头颈外科行喉全切术且无放疗史、化疗史及严重合并症的52例初治患者的临床资料.分为早期经口进食组和常规经口进食组2组(进食时间分别为术后48 ～72 h和8～10 d),对比2组咽瘘发生率.将经口进食时间与其他可能的咽瘘危险因素纳入多因素模型中进行分析,探讨进食时间是否是咽瘘发生的独立危险因素.同时,比较2组患者住院天数的差异.以SPSS 22.0软件对数据进行统计学分析.结果 2组患者总体咽瘘发生率为19.2％,早期经口进食组患者咽瘘发生率为11.1％,常规经口进食组患者咽瘘发生率为23.5％,2组间差异无统计学意义(连续矫正卡方检验,x2=0.506,P=0.477).多因素分析显示,经口进食时间不是咽瘘发生的独立危险因素(P =0.200,OR=0.242,95％ CI为0.028 ～2.118);术前白蛋白水平是咽瘘发生的独立危险因素,且呈负相关(P=0.039,OR=0.848,95％ CI为0.726 ～0.992).2组患者住院天数差异无统计学意义(Mann-Whitney U秩和检验,U=268,P=0.464).结论 术前无放疗史、化疗史的初治患者,早期经口进食不增加咽瘘的发生率.

abstractsObjective To explore whether early oral feeding after total laryngectomy is safe and effective by evaluating the incidence of pharyngocutaneous fistula (PCF) and the hospital duration.Methods A retrospective cohort study was conducted,including 52 patients underwent total laryngectomy,plus partial tongue base resection (n =2),partial pharyngectomy (n =1),or pedicle flap (n =2) between January 2012 and October 2017.Patients who had a history of preoperative radiotherapy,chemotherapy or chemoradiotherapy,previous surgery for larynx or pharynx and who had severe complications were excluded.Early oral feeding started between 48 h and 72 h postoperatively,while delayed oral feeding started within postoperative day 8-10.The incidences of PCF in two groups were compared to evaluate whether PCF and early oral feeding was related.Multi-variables analysis was conducted to evaluate risk factors for PCF.Results PCF rate was 19.2％ among all patients,11.1％ in patients with early oral feeding and 23.5％ in patients with delayed oral feeding.No significant statistically difference in PCF rate was found between two groups (x2 =0.506,P =0.477).Multi-variables analysis showed that oral feeding time (early or delayed) was not a independent risk factor of PCF (Two classification response variable Logistic regression,P =0.200,OR =0.242,95％CI[0.028-2.118]).But low preoperative albumin level was observed as an independent risk factor for PCF (P =0.039,OR =0.848,95％ CI [0.726-0.992]).A negative correlation was observed between preoperative albumin level and PCF.And also there was not a significant difference in hospital duration between patients with early oral feeding and delayed oral feeding (U =268,P =0.464).Conclusion For patients total laryngectomy with no previous history of radiotherapy,chemotherapy,chemoradiotherapy,early oral feeding after surgery is safe and effective.