围手术期凝血指标与口腔颌面部游离皮瓣相关并发症间的关系  

Relationship between perioperative coagulation indexes and complications associated with oral and maxillofacial free flap

作　　者：朱墨[1,2] 金萬勇 朱载瓯 丁旭 武和明[1,2] 吴姗姗[1,3] 顾宁[1,3] 吴煜农 宋晓萌[1,2] ZHU Mo;JIN Wanyong;ZHU Zaiou;DING Xu;WU Heming;WU Shanshan;GU Ning;WU Yunong;SONG Xiaomeng(Jiangsu Key Laboratory of Oral Diseases,Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]南京医科大学口腔疾病研究江苏省重点实验室,南京医科大学,江苏南京210000 [2]南京医科大学附属口腔医院口腔颌面外科,江苏南京210000 [3]南京医科大学附属口腔医院检验科,江苏南京210000

出　　处：《口腔医学》2021年第6期521-526,共6页Stomatology

基　　金：国家自然科学基金(81772887);江苏省医学创新团队资助项目(CXTD2017036);江苏省高校优势学科建设工程(2018-87)。

摘　　要：目的研究围手术期凝血相关指标与口腔颌面恶性肿瘤游离皮瓣修复术后皮瓣并发症之间的关系。方法回顾性分析了2015年5月至2019年10月间,因罹患口腔颌面部恶性肿瘤于我院口腔颌面外科行肿瘤根治术,同期行游离皮瓣修复重建的患者资料,采集了患者术前、术后第一日晨血的凝血功能检验结果,同时记录患者术后皮瓣相关并发症情况。依据患者是否发生术后并发症情况分为两组,出现皮瓣相关并发症的患者分入观察组,其余分入对照组。使用SPSS 23.0软件,定量资料采用t检验,定性资料采用卡方检验,P<0.05时提示差异存在统计学意义。结果本次研究纳入270例患者,其中12例(4.4%)分入观察组,258例(95.6%)分入对照组。患者的年龄、是否放化疗、烟酒摄入史与皮瓣并发症的发生之间未见显著相关性。观察组的术前D-二聚体相较于对照组显著下降(P<0.001),而术后第一日晨血的纤维蛋白原显著上升(P=0.012)。单因素逻辑回归显示术后第一日纤维蛋白原(P=0.015)与术后皮瓣危象显著相关。其他凝血指标两组之间未见差异。结论口腔颌面恶性肿瘤游离皮瓣修复患者的术前D-二聚体的降低及术后第一日纤维蛋白原的升高可能提示术后皮瓣相关并发症的发生。Objective To study the relationship between perioperative coagulation related indexes and postoperative complications of free flap repair for oral and maxillofacial malignant tumor. Methods From May 2015 to October 2019, the data of patients who suffered from oral and maxillofacial malignant tumor and underwent radical resection and free flap reconstruction in oral and maxillofacial surgery of our hospital were retrospectively analyzed. The blood coagulation function test results of patients before and on the first morning after operation were collected, and the complications related to flap after operation were recorded. Patients with flap related complications were divided into observation group and the rest were divided into control group. SPSS 23.0 software was used. T test was used for quantitative data and chi-square test was used for qualitative data. P< 0.05 indicated that there was significant difference. Results 270 patients were included in this study, of which 12 cases(4.4%) were divided into observation group and 258 cases(95.6%) were divided into control group. There was no significant correlation between skin flap complications and patients’ age, chemoradiotherapy, history of alcohol and tobacco intake. Compared with the control group, D-dimer in the observation group decreased significantly(P<0.001), while fibrinogen in the first morning blood increased significantly(P=0.012). Univariate logistical regression analysis showed that fibrinogen in the first morning blood was in significant correlation with flap compromise. There was no difference in other coagulation indexes between the two groups. Conclusion The decrease of D-dimer before operation and the increase of fibrinogen 12 hours after operation in patients with oral and maxillofacial malignant tumor treated with free flap may indicate the occurrence of flap related complications.

关 键 词：口腔恶性肿瘤 皮瓣相关并发症 D-二聚体 纤维蛋白原 

分 类 号：R782.053[医药卫生—口腔医学]