55例口腔颌面头颈部恶性肿瘤患者围手术期死亡病例回顾性分析  

55 cases of perioperative mortality in oral maxillofacial head and neck cancer patients:a retrospective analysis

作　　者：孙中毅 陈一铭[2] 汪轶[3] 季彤[2] SUN Zhongyi;CHEN Yiming;WANG Yi;JI Tong(Department of Oral and Maxillofacial Surgery,the Central Hospital of JA MU SI City,Jamusi 154002,China;Department of Oral and Maxillofacial Head and Neck Oncology,Shanghai Ninth People′s Hospital,College of Stomatology,Shanghai Jiao Tong University,Shanghai Key Laboratory of Stomatology,Shanghai Research Institute of Stomatology,National Clinical Research Center of Stomatology,Shanghai 200011,China;Department of General dentistry,Shanghai Ninth People′s Hospital,College of Stomatology,Shang-hai Jiao Tong University,Shanghai Key Laboratory of Stomatology,Shanghai Research Institute of Stomatology,National Clinical Research Center of Stomatology,Shanghai 200011,China)

机构地区：[1]黑龙江佳木斯中心医院口腔颌面外科,黑龙江佳木斯154002 [2]上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科,上海市口腔医学重点实验室,上海市口腔医学研究所,国家口腔疾病临床研究中心,上海200011 [3]上海交通大学医学院附属第九人民医院口腔综合科,上海市口腔医学重点实验室,上海市口腔医学研究所,国家口腔疾病临床研究中心,上海200011

出　　处：《口腔疾病防治》2020年第9期575-580,共6页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：上海市科委中央引导地方项目(YDZX20173100004422);上海申康发展中心项目(16CR2004A)。

摘　　要：目的探讨口腔颌面头颈部恶性肿瘤患者围手术期死亡病例的临床特点。方法回顾1999年1月~2019年12月于上海交通大学医学院附属第九人民医院口腔颌面头颈肿瘤科治疗并发生围手术期死亡的口腔颌面头颈部恶性肿瘤患者的一般资料、病理诊断以及临床治疗信息;围手术期死亡因素分为外科因素、内科因素、复合因素(内科因素联同外科因素)以及个人因素,使用SPSS17.0软件统计分析不同前提下死亡因素组成差异。结果最终纳入55例患者:男性39例,女性16例。12例具有吸烟史,28例患有基础性疾病。20例接受过术前放疗,9例接受过术前化疗。37例病理学诊断为鳞状细胞癌,9例肿瘤位于上颌骨及颅底区域。围手术期死亡4例发生于术前,1例发生于术中,50例发生于术后。死亡主要因素中:外科因素以颈总动脉破裂为主(8例),内科因素以肺部感染为主(6例),复合因素以血肿合并肺部感染为主(4例),个人因素死亡2例。美国麻醉医师协会(American Society of Anesthesiologist,ASA)评分越高的患者,死亡因素中内科因素占比更高(P=0.039)。结论口腔颌面头颈部恶性肿瘤患者围手术期死亡因素组成较为复杂:颈总动脉破裂是最常见、最致命的外科因素,尤其针对术前接受过放疗的患者;肺部感染是最常见内科并发症;ASA评分越高,围手术期死亡内科因素占比越高。Objective To analyze the characteristics of perioperative mortality(POM)in oral maxillofacial head and neck cancer patients.Methods A retrospective study was adapted for head and neck cancer patients who were treated and had POM in the department of oral maxillofacial&head and neck oncology in Shanghai Ninth People′s Hospital from Jan 1999 to Dec 2019.Demographic information,disease characteristic and clinical records were collected.The factors of POM were classified into surgical complication,medical complication,mixed complication(surgical and medical)and personal complication.SPSS 17.0 software was used to analyze the cause composition for POM under different condition.Results 55 patients were included:39 were male,and 16 were female.A total of 12 patients had a smoking history.Furthermore,28 patients had general comorbidities.20 underwent preoperative radiotherapy and 9 received preoperative chemotherapy.Squamous cell carcinoma was the most frequent pathological diagnosis in 37 patients.A total of 9 patients had tumors in the maxilla and skull base.In addtition,4 patients had POM preoperatively,1 patient had POM within the operation,and 50 patients had POM postoperatively.The leading causes of death were as follows:rupture of the carotid artery was the most frequent(8),and the surgical complication of pulmonary infection was the main medical complication(6).Pulmonary infection and hemorrhage were regarded as the main mixed complication(4).Two patients had POM due to personal complications.The higher the American Society of Anesthesiologists(ASA)score,the higher the proportion of medical factors in POM(P=0.039).Conclusion The composition of POM in oral maxillofacial-head and neck cancer(OMHNC)patients was complicated.Carotid artery rupture was the most common and fatal surgical complication,especially for those who underwent preoperative radiotherapy.Pulmonary infection was the most frequent medical complication,and those who had a higher ASA grade tended to have more complication.

关 键 词：口腔颌面头颈部恶性肿瘤 围手术期死亡 颈总动脉破裂 放疗 化疗 肺部感染 ASA评分 

分 类 号：R782[医药卫生—口腔医学]