口腔癌患者非计划再次手术的影响因素分析  

Analysis of influencing factors of unplanned reoperation in patients with oral cancer

作　　者：王光满 毕小琴[2] WANG Guangman;BI Xiaoqin(West China School of Nursing,Sichuan University,Chengdu,Sichuan 610041,China;State Key Laboratory of Oral Diseases/National Center for Stomatology/National Clinical Research Center for Oral Diseases/Department of Head and Neck Oncology,West China Hospital of Sichuan University,Chengdu,Sichuan 610041,China)

机构地区：[1]四川大学华西护理学院,成都610041 [2]口腔疾病防治全国重点实验室/国家口腔医学中心/国家口腔疾病临床医学研究中心/四川大学华西口腔医院头颈肿瘤外科,成都610041

出　　处：《重庆医学》2024年第9期1353-1359,共7页Chongqing medicine

基　　金：四川省科技计划项目(2022JDKP0007);成都市卫生健康委员会医学科研课题(2022015)。

摘　　要：目的分析口腔癌患者非计划再次手术(UR)的相关影响因素。方法选取2018年1月1日至2022年12月31日四川大学华西口腔医院头颈肿瘤外科160例口腔癌UR患者为研究组,另以1∶1配对选取同期未发生UR的160例患者为配对组,比较两组临床资料,筛选符合要求的变量,进一步采用多因素logistic逐步回归模型分析口腔癌UR的影响因素。结果口腔癌患者UR多发生于术后1 d内(66.88%),原因主要为皮瓣血管危象(48.13%);与配对组比较,研究组患者住院时间延长,住院费用增多,差异均有统计学意义(P<0.05)。多因素logistic逐步回归分析结果显示:清蛋白和中性粒细胞-淋巴细胞比值评分(ANS,OR=1.693,95%CI:1.207~2.347,P=0.002)、手术前后血红蛋白水平差值(OR=1.056,95%CI:1.035~1.077,P<0.001)、游离组织瓣修复(OR=4.609,95%CI:2.350~9.036,P<0.001)是口腔癌患者发生UR的影响因素。结论UR延长患者住院时间,增加患者住院费用。ANS高、手术前后血红蛋白水平差值大、行游离组织瓣修复是口腔癌患者发生UR的独立危险因素。Objective To investigate the related influencing factors of unplanned reoperation(UR)in patients with oral cancer.Methods A total of 160 oral cancer patients with UR who were hospitalized in the Department of Head and Neck Oncology,West China Hospital of Stomatology,Sichuan University from January 1,2018 to December 31,2022 were selected as the study group,and another 160 patients without UR in the same period were selected as the matching group by 1∶1 matching.The clinical data of the two groups were compared.The variables that met the requirements were screened.The multivariate logistic stepwise regression model was further used to analyze the influencing factors of UR in oral cancer.Results UR mostly occurred within one day after surgery in patients with oral cancer(66.88%),mainly due to flap vascular crisis(48.13%).Compared with the matched group,the hospitalization time of the study group was prolonged,the hospitalization cost was increased,and the differences were statistically significant(P<0.05).Multivariate logistic stepwise regression analysis showed that albumin and neutrophil-lymphocyte-ratio score(ANS,OR=1.693,95%CI:1.207-2.347,P=0.002),difference in hemoglobin levels before and after surgery(OR=1.056,95%CI:1.035-1.077,P<0.001)and free tissue flap repair(OR=4.609,95%CI:2.350-9.036,P<0.001)were the influencing factors for UR in patients with oral cancer.Conclusion UR prolongs the hospitalization time and increases the hospitalization cost of patients.High ANS,large difference in hemoglobin levels before and after surgery,and free tissue flap repair are independent risk factors for UR in patients with oral cancer.

关 键 词：口腔癌 非计划再次手术 清蛋白 中性粒细胞与淋巴细胞比值 血红蛋白 游离组织瓣 影响因素 病例对照研究 

分 类 号：R739.8[医药卫生—肿瘤]