围手术期异体输血对口腔癌患者一期游离皮瓣修复重建的预后质量影响  

Effect of perioperative allogeneic blood transfusion on the prognostic quality of first-stage free flap repair and reconstruction in patients with oral cancer

作　　者：丁宜君 李晨曦[2,3,4] 刘慧 秦君玫 DING Yijun;LI Chenxi;LIU Hui;QIN Junmei(Intensive Care Unit(ICU),People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,China;Department of Oral and Maxillofacial Oncology Surgery,The First Affiliated Hospital of Xinjiang Medical University,School/Hospital of Stomatology,Xinjiang Medical University;Stomatological Research Institute of Xinjiang Uygur Autonomous Region;School of Stomatology,Tongji Medical College,Huazhong University of Science and Technology;Shanghai Key Laboratory of Craniomaxillofacial Development and Disease,Department of Oral and Maxillofacial Surgery,Shanghai Stomatological Hospital&School of Stomatology,Fudan University)

机构地区：[1]新疆维吾尔自治区人民医院重症医学科,新疆乌鲁木齐830001 [2]新疆医科大学第一附属医院(附属口腔医院)口腔颌面肿瘤外科 [3]新疆维吾尔自治区口腔医学研究所 [4]华中科技大学同济医学院附属协和医院口腔医学中心 [5]上海市口腔医院口腔颌面外科上海市颅颌面发育与疾病重点实验室

出　　处：《中国输血杂志》2023年第5期428-431,共4页Chinese Journal of Blood Transfusion

基　　金：口腔颌面发育与再生湖北省重点实验室开放课题(2022kqhm008);新疆维吾尔自治区自然科学基金(2021D01C142)。

摘　　要：目的研究围手术期异体输血对口腔鳞癌一期游离皮瓣移植术后患者的影响。方法回顾性分析本院2010年1月—2019年1月306例口腔颌面部鳞癌患者,接受一期游离皮瓣移植修复重建手术的临床资料,根据围手术期接受异体输血的量将其分为未输血组、输血1~2 U组和输血3+U组,比较3组患者皮瓣感染、血运障碍、血肿等并发症的发生率,Kaplan-Meier分析3组患者的5年生存率,同时采用Cox回归分析3组患者死亡的相对风险。结果纳入患者的基线资料包括性别、年龄、肿瘤部位、分化程度、辅助放化疗等,3组患者无差异(P>0.05)。输血3+U组患者的并发症发生率(25.97%)均明显高于未输血组(6.12%)和输血1~2U组(10.68%)(P<0.05);输血3+U组患者的5年生存率(51.95%)均明显低于未输血组(69.38%)和输血1~2 U组(62.60%)(P<0.05)。单因素分析结果显示,年龄、辅助放疗、组织分化程度、瘤旁浸润、血管浸润及输血均是口腔鳞癌术后的预后质量影响因素(P<0.05)。多因素分析结果显示,辅助放化疗是OSCC术后预后质量的独立保护因素(P<0.01);分化程度、血管浸润及输血是OSCC术后预后质量的独立危险因素(P<0.05)。结论口腔鳞癌患者围手术期异体输血可增加一期游离皮瓣移植修复重建术后并发症风险,同时可直接影响患者预后质量,可作为口腔鳞癌患者预后的重要危险因素。Objective To study the effect of perioperative allogeneic blood transfusion on patients with oral squamous cell carcinoma(OSCC)after first-stage free flap transplantation.Methods A total of 306 OSCC patients who accepted primary repair and reconstruction using free flap admitted to our affiliation from January 2010 to January 2019 were selected as the research objects and retrospectively analyzed.According to their clinical data,they were divided into three groups:no transfusion group(n=98),1-2 U transfusion group(n=131)and 3+U transfusion group(n=77),respectively.The incidence of complications including flap infection,blood circulation disorder and hematoma in the three groups were compared.The five-year survival rate of the three groups was calculated by Kaplan-Meier analysis,and the relative risk of death was analyzed by Cox regression.Results There was no statistically significant difference among the three groups of patients(P>0.05)regarding such baseline data as embracing gender,age,primary location,degree of differentiation,adjuvant radiotherapy and chemotherapy.The complication rate of patients with 3+U transfusion(25.97%)was significantly higher than that of no transfusion(6.12%)and 1-2 U transfusion(10.86%)(P<0.05);and the five-year survival rate of patients with 3+U transfusion(51.95%)was significantly lower than that of no transfusion(69.38%)and 1-2 U transfusion(62.60%)(P<0.05).The results of univariate analysis showed that age,adjuvant radiotherapy,degree of tissue differentiation,collateral infiltration,vascular invasion and blood transfusion were all factors influencing the quality of prognosis after repair and reconstruction of first-stage free flap transplantation treating OSCC(P<0.05).The results of multivariate analysis showed that adjuvant chemoradiotherapy was an independent protective factor for the prognosis and survival quality of postoperative OSCC patients(P<0.01);the degree of differentiation,vascular invasion and blood transfusion were independent risk factors for the prognosis and su

关 键 词：围手术期 异体输血 口腔鳞癌 游离皮瓣手术 预后质量 

分 类 号：R457.1[医药卫生—治疗学] R739.8[医药卫生—临床医学]