Abstract：
OBJECTIVE: We evaluated vessel counts in the pharyngeal mucosal margins of patients who underwent salvage laryngectomy to establish whether mucosal vascularity might predict fistula risk.
METHODS: Retrospective cohort.
METHODS: Tertiary Medical Center.
METHODS: Patients who underwent salvage total laryngectomy at our institution between 1999 and 2015 were identified. Pharyngeal mucosal margins from laryngectomy specimens were evaluated histologically for each patient, and vessel counts were performed on 5 ×10 images. The primary outcome measure was fistula within 30 days of surgery and mean vessel counts were assessed as the principle explanatory variable.
RESULTS: Seventy patients were included and 40% developed a postoperative fistula. There was a large difference in the mean vessel count in patients who did develop fistula (48.6 vessels/×10 field) compared to those who did not (34.7 vessels/×10 field). A receiver operative characteristic curve found that a cutoff value of 33.9 vessels/×10 field provided a sensitivity of 75% and specificity of 62% to predict the likelihood of fistula occurrence (area under the curve = 0.71, 95% confidence interval [CI]: 0.59-0.83). In a binary logistic regression, patients with vessel counts greater than 33.9 had a 5-fold increased risk of developing fistula (95% CI: 1.8-16.45). Histologically, vessels in the pharyngeal mucosa of patients who developed fistulas were more disorganized.
CONCLUSIONS: After salvage laryngectomy, patients with higher mean mucosal margin vessel counts are at increased risk of fistula. The mechanism is unknown, but the disorganization of the vasculature may contribute to poor wound healing. Vessel counting may allow for fistula risk stratification and guide postoperative care.
METHODS: Retrospective cohort.
METHODS: Tertiary Medical Center.
METHODS: Patients who underwent salvage total laryngectomy at our institution between 1999 and 2015 were identified. Pharyngeal mucosal margins from laryngectomy specimens were evaluated histologically for each patient, and vessel counts were performed on 5 ×10 images. The primary outcome measure was fistula within 30 days of surgery and mean vessel counts were assessed as the principle explanatory variable.
RESULTS: Seventy patients were included and 40% developed a postoperative fistula. There was a large difference in the mean vessel count in patients who did develop fistula (48.6 vessels/×10 field) compared to those who did not (34.7 vessels/×10 field). A receiver operative characteristic curve found that a cutoff value of 33.9 vessels/×10 field provided a sensitivity of 75% and specificity of 62% to predict the likelihood of fistula occurrence (area under the curve = 0.71, 95% confidence interval [CI]: 0.59-0.83). In a binary logistic regression, patients with vessel counts greater than 33.9 had a 5-fold increased risk of developing fistula (95% CI: 1.8-16.45). Histologically, vessels in the pharyngeal mucosa of patients who developed fistulas were more disorganized.
CONCLUSIONS: After salvage laryngectomy, patients with higher mean mucosal margin vessel counts are at increased risk of fistula. The mechanism is unknown, but the disorganization of the vasculature may contribute to poor wound healing. Vessel counting may allow for fistula risk stratification and guide postoperative care.
摘要：
目的：我们评估了接受挽救性喉切除术的患者咽部粘膜边缘的血管计数，以确定粘膜血管是否可以预测瘘管风险。
方法：回顾性队列。
方法：三级医疗中心.
方法：确定了1999年至2015年在我们机构接受了挽救性全喉切除术的患者。对每位患者的喉切除术标本的咽粘膜边缘进行组织学评估，和血管计数在5×10图像上进行。主要结局指标是手术后30天内的瘘管，平均血管计数被评估为主要解释变量。
结果：纳入70例患者，40%的患者发生术后瘘。与未发生瘘管的患者（34.7血管/×10视野）相比，发生瘘管的患者的平均血管计数差异很大（48.6血管/×10视野）。受试者操作特征曲线发现，截止值33.9血管/×10视野提供了75％的灵敏度和62％的特异性，以预测瘘管发生的可能性（曲线下面积=0.71，95％置信区间[CI]：0.59-0.83）。在二元逻辑回归中，血管计数大于33.9的患者发生瘘管的风险增加5倍(95%CI:1.8~16.45).组织学上,发生瘘管的患者的咽粘膜中的血管更加混乱。
结论：挽救性喉切除术后，平均粘膜边缘血管计数较高的患者发生瘘管的风险增加.机制未知,但是脉管系统的紊乱可能导致伤口愈合不良。血管计数可以允许瘘管风险分层并指导术后护理。
方法：回顾性队列。
方法：三级医疗中心.
方法：确定了1999年至2015年在我们机构接受了挽救性全喉切除术的患者。对每位患者的喉切除术标本的咽粘膜边缘进行组织学评估，和血管计数在5×10图像上进行。主要结局指标是手术后30天内的瘘管，平均血管计数被评估为主要解释变量。
结果：纳入70例患者，40%的患者发生术后瘘。与未发生瘘管的患者（34.7血管/×10视野）相比，发生瘘管的患者的平均血管计数差异很大（48.6血管/×10视野）。受试者操作特征曲线发现，截止值33.9血管/×10视野提供了75％的灵敏度和62％的特异性，以预测瘘管发生的可能性（曲线下面积=0.71，95％置信区间[CI]：0.59-0.83）。在二元逻辑回归中，血管计数大于33.9的患者发生瘘管的风险增加5倍(95%CI:1.8~16.45).组织学上,发生瘘管的患者的咽粘膜中的血管更加混乱。
结论：挽救性喉切除术后，平均粘膜边缘血管计数较高的患者发生瘘管的风险增加.机制未知,但是脉管系统的紊乱可能导致伤口愈合不良。血管计数可以允许瘘管风险分层并指导术后护理。
