Review and prospect of theoretical research on Sanming medical reform based on bibliometrics / 中华医院管理杂志

Objective:To analyze the research hotspots and change trends of Sanming medical reform theory in China from 2013 to 2019, so as to provide reference for the relevant research of medical reform in China.Methods:The theoretical and empirical studies on Sanming medical reform from 2013 to 2019 in relevant databases at home and abroad were screened. The literature metrology method was used to analyze the overall trend of domestic literature. The keyword cloud method was used to analyze the research hotspots and main problems.Results:After screening, a total of 59 literatures were obtained. It was found that the reform of public hospitals was the hotspot of current research. Three medical linkage, governance system, annual salary system and medical insurance integration were the core contents of researches.Conclusions:The research of Sanming medical reform is in the initial stage of development. In the future, the research on medical reform can be further deepened around the relevant basic theories, normative and specific research, and so on.

Incidence and risk factors for late-onset sepsis in very low birth weight infants / 中华围产医学杂志

Objective:To investigate the clinical characteristics, pathogen distribution and risk factors of late-onset sepsis (LOS) in very low birth weight infants (VLBWI).Methods:In this retrospective case-control study, 107 VLBWIs diagnosed with LOS and hospitalized in Fujian Provincial Maternity and Children's Hospital from January 1, 2010 to December 31, 2015 were enrolled as LOS group. Another 107 VLBWIs without infection were assigned as control group with an allocation ratio of 1 to 1. The clinical data between groups were compared using two-independent sample t-test, Chi-square test, sum-rank test and univariate analysis of variance, and multivariate logistic regression was used to analyze the risk factors of LOS. Results:The incidence of LOS in VLBWI was 8.6% (107/1 239). Among the 107 cases with LOS, 87 recovered with a cure rate of 81.3%. Various clinical presentations were observed, and the most common included lethargy (83/107, 77.6%), abdominal distention (77/107, 72.0%) and dyspnea (76/107, 71.0%). Increased C-reactive protein (CRP) level was the most common laboratory markers (82/107, 76.6%). The blood cultures were positive in 45 (42.1%) cases and the dominant pathogen was Gram-negative bacteria (32/45, 71.1%), especially Klebsiella. The logistic regression analysis showed that mechanical ventilation ( OR=21.181, 95% CI: 1.542-290.948, P=0.022), feeding intolerance ( OR=12.480, 95% CI: 2.602-59.856, P=0.002), combined application of antibiotics before LOS occurs ( OR=22.457, 95% CI: 3.933-128.237, P<0.001), duration of antibiotic treatment before LOS occurs ( OR=1.388, 95% CI: 1.158-1.663, P<0.001) were the independent risk factors of LOS for VLBWI. Conclusions:The clinical presentation of LOS in VLBWI are diverse and non-specific. Increased CRP level is a sensitive laboratory marker. The main pathogen is Gram-negative bacteria. LOS are more prone to occur in VLBWI with mechanical ventilation, feeding intolerance, combined application of antibiotics or long duration of antibiotic treatment.

Relationship between early-onset neonatal sepsis and the level of interleukin-6, C-reactive protein in umbilical cord serum of the newborns with premature rupture of membrane / 中国新生儿科杂志

Objective To study the levels of interleukin-6 (IL-6) and C-reactive protein(CRP) in umbilical cord serum of the newborns with premature rupture of membrane(PROM)and to explore the value of IL-6 and CRP in the diagnosis of early onset neonatal sepsis (EONS).Method A total of 187 term newborns with PROM ＞ 12 h who were born normal vaginally in our Hospital from April 2015 to December 2015 were enrolled in this study as the PROM group and another 50 term infants without PROM and infection as the control group.The levels of IL-6 and CRP in umbilical cord serum were quantified by ELISA,the results of which were compared between groups.Receiver operating characteristics (ROC) curves were drawn to find out the cut-off value of IL-6 and CRP for the diagnosis of EONS.Result The levels of IL-6 and CRP in umbilical cord serum in the PROM group were significantly higher than those in the control group [IL-6 20.3 (9.5,35.8) pg/ml vs.9.3 (6.9,27.5) pg/ml,CRP 0.42 (0.25,0.78) mg/L vs.0.33 (0.18,0.45) mg/L,P ＜ 0.05].The levels of IL-6 and CRP in the newborns whose mother had chorioamnionitis were significantly higher than those in the newborns whose mother was without chorioamnionitis [IL-6 62.5 (35.2,92.7) pg/ml vs.10.8 (9.3,33.4) pg/ml,CRP 0.86 (0.44,1.95) mg/L vs.0.35 (0.20,0.62) mg/L,P ＜0.05].The levels of IL-6 and CRP in the infants with PROM≥18 h was significantly higher than those in the infants with PROM ＜ 18 h [IL-6 32.1 (9.9,42.2) pg/ml vs.10.7 (9.2,32.6) pg/ml,CRP 0.44(0.29,0.86) mg/L vs.0.35 (0.23,0.61) mg/L,P ＜ 0.05].The levels of IL-6 and CRP in the neonates with EONS was significantly higher than those in the neonates without EONS [IL-6 92.0 (58.3,161.0) pg/ml vs.20.0(9.4,35.2)pg/ml,CRP 1.94(0.47,2.73) mg/L vs.0.38(0.24,0.67) mg/L,P ＜ 0.05].ROC curve analysis showed that the cut-off value of IL-6 and CRP for the diagnosis of EONS were 81.lpg/ml (sensitivity 76.5％,specificity 90.6％) and 1.88mg/L (sensitivity 64.7％,specificity 89.4％).With the combination of IL-6 and CRP levels,the sensitivity was 88.2％ and the specificity was 84.1％ for the diagnosis of EONS.Conclusion To measure the IL-6 and CRP levels in umbilical cord serum is helpful for the early diagnosis of EONS,and the combined detection of the 2 items may improve the sensitivity of diagnosis.

Early targeted therapy treatment of patent ductus arteriosus with ibuprofen and hydrocortisone in premature infants with low cortisol level / 中国新生儿科杂志

Objective To evaluate the role of ibuprofen and hydrocortisone in early treatment of patent ductus arteriosus ( PDA ) in premature infants with low cortisol level . Method A prospective randomized controlled trial on 144 very low birth weight infants in the Hospital within 24 hours after birth with gestational age of 28~32 weeks and birth weight of 1000~1499 grams,who had asymptomatic PDA diagnosed by echocardiography , introducing early administration of drugs including ibuprofen and /or hydrocortisone within the first 24 ~48 hours after birth.According to the baseline of serum cortisol level measured prior to the administration of drugs , the preterm were assigned into two groups .The low cortisol level group ( the cortisol level <150μg/L) were further subdivided into four groups each being allocated to hydrocortisone or ibuprofen or both of hydrocortisone and ibuprofen combined or placebo treatment .The high cortisol level group ( the cortisol level≥150μg/L) were allocated to either ibuprofen or placebo treatment in randomization.Diameter of ductus arteriosus and cortisol value were measured again after treatment , and the follow-ups were undertaken till discharge .All data was collected and analyzed by statistical software .Result A total of 91 cases were in low cortisol level group ( 22 cases of hydrocortisone , 23 cases of ibuprofen , 21 cases of both hydrocortisone and ibuprofen , and 25 cases of placebo ) and 53 cases in high cortisol level group (26 cases of placebo and 27 cases of Ibuprofen ).Low cortisol level group , combined therapy , closure of the ductus at a rate of 81.0%, was higher than other methods of therapy ( P<0.05);high cortisol level group, the ductus arteriosus closed in 20 patients of ibuprofen therapy ( 74.1%) and in 13 patients of placebo treatment (50.0%) (P<0.05).Early treatment did not significantly increase the drug adverse effects, including impaired renal function , gastrointestinal bleeding , hyperglycemia and others. After comparisons between laboratory changes in early targeted groups and non-early targeted groups after treatment, findings were as follows: decrease in the incidence of apnea , myocardial damage , feeding intolerance , intraventricular hemorrhage and reduce the duration of phototherapy .Conclusion This trial proved the efficacy and safety of early therapy with ibuprofen and hydrocortisone for closure of ductus arteriosus in premature infants with low cortisol level and the decreasing incidence of complications due to PDA without increasing the risk of adverse effects .

Clinical analysis of inherited metabolic diseases in the neonatal intensive care unit / 中华实用儿科临床杂志

Objective To study the clinical characteristics of inherited metabolic disease(IMD) in the neonatal intensive care unit and to improve the ability of early diagnosis of the disease.Methods A total of 5 590 newborns were hospitalized in the Neonatal Intensive Care Unit (NICU),Fujian Maternity and Children Hospital between January 2012 and April 2015,and 340 neonates who were suspected of IMD consecutively were recruited.Tandem mass spectrometry and gas chromatography-tandem mass spectrometry were used to diagnose IMD.A retrospective study of analyzing the clinical characteristics of the patients of IMD in the NICU was conducted.Results Fifteen neonates were diagnosed as IMD,among whom methylmalonic academia,maple syrup urine disease,hyperphenylalaninemia,citrin deficiency,propionic acidemia,glutaric academia,ornithine transcarbamylase deficiency and primary carnitine deficiency were 5,2,2,2,1,1,1 and 1,respectively.Sixty-six point seven percent (10/15 cases) of IMD onset in the first week after birth were severe.Clinical presentations include the nervous was severe,digestive system and respiratory system symptoms,such as poor response,coma,lethargy,dystonia,convulsion,shortness of breath,dyspnea,milk refusal,diarrhea,jaundice,and so on.The main early manifestations were anorexia,lethargy,seizures and shortness of breath,which were nonspecific.Conclusions Clinical manifestations of IMD are nonspecific.The earlier onset of the disease is more serious,and early tandem mass spectrometry and gas phase chromatography-mass spectrometry are useful for early diagnosis and may guide early clinical intervention.

Clinical application of a new skin-stretching device / 中国组织工程研究

BACKGROUND:Previously deep burn wound or skin defects are generaly repaired with skin grafting or flap of skin grafting. Obvious scar hyperplasia usualy appears after operation, which requires multiple surgeries. Meanwhile, patients have to suffer from great pain and bear high cost. OBJECTIVE: To observe the clinical effects on deep wounds by continuous traction of self-designed skin-stretching device (patent No. ZL 2012 2 0022443.7). METHODS: Thirty patients with deep burn wound, skin defect or funicular scar were enroled, including 22 males and 8 females, aged 18-49 years, and randomly divided into two groups. Skin-stretching device was adopted for skin traction treatment. Twenty cases underwent skin traction from 1 kg puling force to 5 kg, with an increase of 1 kg per 2 days, 6 hours a day for 10 days. Blood flow at the beginning, 1, 5, 10, 15, 20, 30, 60 minutes of the skin traction, and the changes of wound edge skin as wel as histological changes of the skin were observed. Of the remaining 10 cases, 2, 6, and 2 cases underwent skin traction of 2, 4, 7 kg, respectively. Blood flow and skin changes were also observed to find out the most suitable and safe force. RESULTS AND CONLUSION:Al the 30 cases achieved primary healing without necrosis of skin, infection or peripheral circulatory disorders, and the appearance and function recovered wel. The healing time was 8-24 days. The skin-stretching device was most safe under 4 kg puling force, by which, there was neither blood circulation obstacle nor tear of skin. After traction, the skin blood flow and the number of cels increased, especialy the epithelial basal cels. The colagen fibers became thicker and denser, and the elastic fibers regenerated significantly; the fibroblasts and capillary density increased. It has been proved that we can better close the wound and reduce scar formation effectively with the self-designed skin-stretching device for skin traction.

Punctate clinical application of modified composite graft to autologous skin with irradiated xenogeneic skin / 国际外科学杂志

Objective Clinical effects of dot from body skin irradiated xenogeneic skin improved composite graft.Methods Selected 80 patients with severe burn patients randomized after admission on the basis of conventional treatment,3-5 days line Crust treatment group transplanted autologous point-like skin irradiation pigskin coverage.Results Treatment of patients in group one week dressing see irradiated pigskin Tiefu full two weeks the pigskin was dry scab-like.Wound healing treatment group (29 ± 5) days (P ＜ 0.01) was significantly shorter than the control group(39 ±4) days.Wound healing rate of treatment is significantly higher than the control group (P ＜0.01).Wound infection rate reduced greatly reduce labor intensity and dressing,and reduce pain.1 year after scar formation in patients with good flexibility and functionality.Conclusions Punctate since improved composite body skin irradiated xenogeneic skin transplantation can improve skin graft survival rate,promote wound healing,treatment of a large area of the burn wound repair is feasible and effective.

Immune effect of propylthiouracil and methimazole in the treatment of Graves' disease / 中华内分泌代谢杂志

ObjectiveTo observe the changes in TSH receptor antibody (TRAb) and soluble intercellular adhesion molecule-1 ( sICAM-1 ) levels after treatment of propylthiouracil ( PTU ) and methimazole( MMI ) in patients with Graves' disease (GD). MethodsOne hundred and six cases of clinically diagnosed patients with GD were divided into PTU and MMI groups( each group, n =53 ). The patients in two groups were regularly followed for 36 months. TRAb and sICAM-1 were measured with ELISA method. Results( 1 ) The general data of two groups were not significantly different before treatment( all P＞0. 05 ). ( 2 ) There was no difference in TRAb positive rates between two groups before treatment. The clinical remission rates between PTU and MMI groups showed no difference (83.02％ vs88.68％ ). The cure rate was higher in MMI group than in PTU group( 58.49％ vs 37.74％, P＜ 0. 05 ). (3) There existed significant differences in TRAb levels determined before and 6, 12, 24,30, and 36 months after treatment( all P＜0. 01 ), being gradually decreased with time( F=275.48 ,P＜0.01 ). TRAb levels between two groups were significantly different( F=5.86, P＜0. 05 ). (4) sICAM-1 levels at 36 months after treatment compared with the baseline in both groups were statistically different (P＜0. 01 ), but no difference was found between two groups.ConclusionsBoth PTU and MMI improve the immune status of patients with GD,and the immunosuppressive effect of methimazole is more evident.

Treatment of burn complicated fracture / 国际外科学杂志

Objective To analyze the treatment principles of burn patients with fractures and the clinical application of external fixation.Methods The treatment methods and efficacy in 48 patients with bum complicated fracture were summarized.Limb fractures were 53,femoral shaft 21,tibia and fibula 28,humerus 13,ulnar bone torsion 5.Closed 44,open 23.All limbs received external fixation,with single-arm multifunctional external fixator in 47,bilateral 17,Monteggia 3.Burn wound dressing was dealed with the situation in accordance with surgical debfidement or skin flap.Results The 48 cases were found no deaths,and 67 fractures healed and discharged healing time 2.5～5 months,3.1 months on average.Limb and joint function showed a good recovery.Conclusions External fixation showed fixation stability,simple operation,mild tissue injury,easy handling and anti-burn scar contracture and other advantages.Clinical results were satisfactory.

Relative factors analysis including carcinoma marker, molecular margin and clinical factors on laryngeal carcinoma recurrence / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the factors of laryngeal carcinoma recurrence, 103 patients of laryngeal carcinoma were analyzed retrospectively on carcinoma marker, molecular margin and clinical factors with univariate analysis and multivariate analysis.@*METHOD@#CyclinD1, p27, p53 and eIF4E in primary site and surgery margins were detected in laryngeal carcinoma recurrence group and unrecurrence group with immunohistochemical staining to explore the significance of CyclinD1, p27, p53 and eIF4E on laryngeal carcinoma recurrence; The clinical data of 103 patients of laryngeal carcinoma were analyzed retrospectively to investigate the clinical factors of laryngeal carcinoma recurrence; At last above three factors were analyzed with multivariate analysis.@*RESULT@#There was significant difference between laryngeal carcinoma recurrence group and unrecurrence group about CyclinD1, p27 and p53 in laryngeal primary site; There was no significant difference between laryngeal carcinoma recurrence group and unrecurrence group about eIF4E. There was significant difference between laryngeal carcinoma recurrence group and unrecurrence group about CyclinD1, p27, p53 and eIF4E in surgery margins. Laryngeal carcinoma recurrence after surgery was related with carcinoma site, T stage, node metastasis, laryngeal carcinoma pathology and operative method; However, it was not related with age, sex and postoperative irradiation therapy with univariate analysis. Laryngeal carcinoma recurrence after surgery was related with T stage, node metastasis, laryngeal carcinoma pathology and operative method with logistic multivariate analysis. At last, laryngeal carcinoma recurrence after surgery was related with T stage, node metastasis, laryngeal carcinoma pathology and positive molecular margins with logistic multivariate analysis.@*CONCLUSION@#The factors of laryngeal carcinoma recurrence is comprehensive. T stage, node metastasis,laryngeal carcinoma pathology and laryngeal carcinoma positive molecular margins were related with laryngeal carcinoma recurrence. Positive molecular margins were more reliable.

Relevance of Endoglin (CD105) VEGF and p53 with invasion metastasis and prognosis of laryngeal carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the clinical significance of microvessel density (MVD) and investigate the relationship of Endoglin (CD105), VEGF and p53 protein and their significance of clinical pathology.@*METHOD@#Pathologic paraffin-embedded tissues and clinic data of 40 patients with primary squamous cell carcinoma of larynx were studied. Serial sections were respectively stained with Endoglin (CD105), VEGF and p53 by immunohistochemistry and its expressions were investigated. Microvessel density (MVD) highlighted by Endoglin (CD105) were counted according to a standard protocol.@*RESULT@#Endoglin (CD105) expression in tumour tissue was significantly higher than in normal mucosa (P < 0.05). The mean MVD value for Endoglin (CD105) was 14. 90 +/- 7.40. The mean CD105-MVD value of T3 and T4 tumours showed a significantly higher staining than that of T1 and T2 tumours; The mean CD105-MVD value of tumours with metastasis was also higher than that of tumours with no metastasis (P < 0.05); The expression of VEGF was observed in cytoplasm of tumour cell and its positive rate was 77.5% in laryngeal carcinoma, which was significantly correlated with TNM stage and pathological differentiation of laryngeal carcinoma (P < 0.05). The expression of p53 protein was mainly observed in nucleolus of tumour cell and its positive rate was 67.5%, which was significantly correlated with metastasis of lymph node. Positive relevance was found between CD105-MVD and VEGF (r = 0.641, P < 0.01); Positive relevance was also found between CD105-MVD and p53 (r = 0.534, P < 0.01).@*CONCLUSION@#Endoglin (CD105) is a marker of tumour angiogenesis for its significant associated with active angiogenesis in laryngeal carcinoma. The study shows that CD105-MVD in laryngeal carcinoma is an independent indicator of predicting invasion, metastasis and recurrence, and evaluating prognosis of malignant tumours. CD105-MVD, VEGF and p53 could be important indicators to evaluate invasion, metastasis and recurrence of laryngeal carcinoma.

Expression and role of survivin in laryngeal squamous cell carcinoma and laryngeal papilloma in adults / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the expression of Survivin in laryngeal squamous cell carcinoma (LSCC) and laryngeal papilloma in adults and its significance in carcinogenesis and development of the LSCC.@*METHOD@#The expressions of Survivin protein were detected by immunohistochemistry technique in 46 cases of LSCC, 24 cases of adjacent nontumorous laryngeal epithelium, 20 cases of laryngeal papilloma and 16 cases of normal laryngeal epithelium.@*RESULT@#The positive rates of Survivin protein expression in laryngeal carcinoma, adjacent nontumorous laryngeal epithelium and laryngeal papilloma were 71.74% (33/46), 33.33% (8/24)and 40.00% (8/20) respectively. There was no expression in normal laryngeal epithelium. The positive rate of Survivin protein expression in laryngeal carcinoma was significantly higher than that in the adjacent nontumorous laryngeal epithelium, laryngeal papilloma and normal laryngeal epithelium. But there was no statistically significant correlations between Survivin protein expression and the clinicopathological characteristics of tumor site, T-stage, pathological grading, UICC-stage and lymph node metastasis (P > 0.05). Expression of Survivin protein in 3 cases in laryngeal papilloma group which turned into laryngeal carcinoma later were all positive.@*CONCLUSION@#There was overexpression of Survivin in the laryngeal carcinoma. The expression of Survivin might play an important role in the carcinogenesis of LSCC and might be an early event during laryngeal carcinogenesis. It could be a diagnostic marker for evaluating the malignant potential of laryngeal papilloma in adults.

Significance of CD105 expression in laryngeal carcinoma / 基础医学与临床

Objective To study the expression of CD105 in laryngeal carcinoma and to evaluate the clinical significance of microvessel density(MVD).Methods Pathologic paraffin-embedded sections and clinical data from 40 patients with primary squmamous cell carcinoma of larynx were studied through immunohistochemistry.Microvessel density(MVD) highlighted by CD105 and CD34 were counted.Results CD105 expression in tumour tissue was significantly higher than normal health mucosa.The mean CD105-MVD value of T3 and T4 tumours showed a significantly deeper staining than T1 and T2;The mean CD105-MVD value of tumours with metastasis was also markedly higher than tumours with no metastasis;The diffenerce of mean CD105-MVD value between in 16 patients with recurred laryngeal carcinoma and in 20 patients with unrecurred laryngeal carcinoma for two years of follow-up was markedly significant(P

Calpain-mediated Cleavage of Atg5 Determine Autophagy or Apoptosis of PMN, and C5a's Role / 生物化学与生物物理进展

Apoptosis of neutrophils controls the duration and the intensity of an inflammatory response and therefore the extent of neutrophil- mediated tissue damage, disturbance of neutrophil apoptosis has been associated with many diseases, underlying mechanism is not elucidated. C5a is a complement fragment that has multifunctional properties, which induces neutrophil chemoattraction, an oxidative burst, enhancement of phagocytosis, release of granule enzymes, and suppress neutrophil apoptosis. Several studies have reported calpain is involved in both neutrophil functions and apoptosis and it might play a more specific role in the regulation of neutrophil apoptosis. Diffenrent isoform of calpains is activted by diffenrent stimuli through different transduction pathway. It was reported previously that calpain is required for neutrophil migration and chemotaxis induced by C5a. In addition, autophagy is a ubiquitous physiological process that occurs in all eukaryotic cells and is considered to be a survival mechanism. Atg5 promotes autophagy and is indispensable to autophagosome formation. Upon calpain activation, Atg5 is cleaved and the resulting 24 ku Atg5 mediates apoptosis while losting the property of autophagy. Therefore, Atg5 represents a molecular switch between autophagy and apoptosis. The interaction among the C5a, calpain and Atg5 was introduced and new direction for further research was provided.

Diagnosis and surgical management of tumors primarily in the pterygopalatine fossa / 中国耳鼻咽喉头颈外科

OBJECTIVE To evaluate the clinical features of tumors primarily in the pterygopalatine fossa, and the efficiency of surgical management for these lesions. METHODS The clinical data of 7 cases with tumors primarily in the pterygopalatine fossa were retrospectively studied. Three of them were primary diseases, i.e. fibrous histiocytoma, neurofibroma and cholesteatoma. The other 4 cases were secondary tumors mainly located in pterygopalatine fossa. There were 1 case with epithelial-myoepithelial carcinoma, 1 case with adenoid cystic carcinoma , 1 case with recurrent inverted nasal papilloma, 1 case with recurrent malignant fibrous histiocytoma. Approaches to tumors in pterygopalatine fossa lesions included lateral rhinotomy, and transnasal or transantrum approaches under the nasal endoscope. RESULTS The patient suffered from adenoid cystic carcinoma developed local recurrence 4 months after operation, and extended resection of the recurrent tumor with laser was performed again. No further recurrence was found after following-up for 3 years. Neither local recurrence nor regional metastasis was found in the remaining 6 cases with a follow-up period of 2 to 4 years. The main complication was oronasal fistula. CONCLUSION CT scan or MRI is the main method to the early diagnosis of pterygopalatine fossa tumors. Lateral rhinotomy, endoscopic trasnnasal or transantrum approaches are feasible procedures to resect the tumors.

Fibrous histiocytoma of the laryngeal glottis / 中国耳鼻咽喉头颈外科

A case of a fibrous histiocytoma (FH) of the larynx in a 54-year-old male is reported. Laryngeal fibrous histiocytoma is uncommon. The case recurred several times over 4-year period. Its pathology is described including arguments on potential malignancy and the way of management.

Study of pharyngo-cutaneous fistula after total laryngectomy / 临床耳鼻咽喉头颈外科杂志

Objective:To explore the factors which lead to pharyngo-cutaneous fistula after total laryngectomy.Method:A retrospective study of 125 patients who underwent total laryngectomy during a 16-year period was carried out.Result:The rate of post-laryngectomy pharyngo-cutaneous fistula is 16.0% (20/125),it appears reduced tendency.With single-factor analysis,the factors effect on the rate of post-laryngectomy pharyngo-cutaneous fistula include clinical tumor stage,tumor types,pre-operative radiotherapy dose,intra-operative blood transfusion,operative duration.With all varible logistic model analysis,the factors effect on the rate of pharyngo-cutaneous fistula are clinical tumor stage and pre-operative radiotherapy dose,but pre-operative radiotherapy is very possible to be a risk factor (P=0.0566).With logistic model stepwise regression analysis,the factors effect on the rate of pharyngo-cutaneous fistula are clinical tumor stage and operative duration.Conclusion:Pharyngo-cutaneous fistula appears easily in patients with T3、T4 tumor,and have pre-operative radiotherapy, especially have large dose preradiotherapy.For these high risk patients,the duration of operation should be as short as possible to reduce the rate of post-laryngectomy pharyngo-cutaneous fistula.