口腔颌面肿瘤患者游离皮瓣修复重建手术后非计划再次手术的原因及危险因素分析  

Analysis of the causes and risk factors of unplanned reoperation after free flap reconstruction in patients with oral and maxillofacial tumors

作　　者：张瑶 郭俊 任德龙 李慧 刘冰 荀泽敏 张惠 ZHANG Yao;GUO Jun;REN Delong;LI Hui;LIU Bing;XUN Zemin;ZHANG Hui(State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration,National Clinical Research Center for Oral Diseases,Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture,Department of Anesthesiology,School of Stomatology,Air Force Medical University,Xi'an 710032,China)

机构地区：[1]口颌系统重建与再生全国重点实验室,国家口腔疾病临床医学研究中心,陕西省口腔生物工程技术研究中心,空军军医大学口腔医院麻醉科,陕西西安710032

出　　处：《空军军医大学学报》2024年第8期868-875,882,共9页Journal of Air Force Medical University

基　　金：国家自然科学基金(82171170);国家口腔疾病临床医学研究中心资助课题(LCA202005);空军军医大学临床研究项目(2023LC2341)。

摘　　要：目的探讨口腔颌面肿瘤患者游离皮瓣修复重建手术后发生非计划再次手术(UPR)的原因及危险因素。方法回顾性收集2020年3月10日至2022年6月14日在空军军医大学口腔医院接受游离皮瓣修复重建手术治疗的口腔颌面肿瘤患者的病历资料,采用logistic回归分析筛选术后住院期间发生UPR的危险因素。结果共纳入528例患者,59例(11.17%)发生UPR,术后24 h内(62.71%)、颈部血肿(37.29%)和静脉危象(33.90%)是主要原因。多因素logistic回归分析显示,手术时长>12 h(OR=21.21,95%CI=1.74~507.05,P=0.02)和既往有头颈部游离皮瓣重建史(OR=3.51,95%CI=1.03~10.41,P=0.03)是UPR发生的独立危险因素(P<0.05)。结论手术时长>12 h和既往有头颈部游离皮瓣重建史的患者在住院期间发生UPR的风险较高,要密切关注患者术后24 h内情况,重点防范游离皮瓣修复重建手术后颈部血肿和静脉危象的发生。Objective To investigate the causes and risk factors of unplanned reoperation(UPR)after free flap reconstruction in patients with oral and maxillofacial tumors.Methods The data from patients with oral and maxillofacial tumors who underwent free flap reconstruction in Stomatological Hospital of Air Force Medical University from March 10,2020 to June 14,2022 were retrospectively collected.Logistic regression analysis was used to screen the risk factors for UPR during postoperative hospitalization.Results A total of 528 patients were included,and 59(11.17%)had UPR,mainly within 24 h after surgery(62.71%).Neck hematoma(37.29%)and venous crisis(33.90%)were the main causes.Multivariate logistic regression analysis showed that the operation duration of more than 12 h(OR:21.21,95%CI:1.74-507.05,P=0.02)and previous history of head and neck free flap reconstruction(OR:3.51,95%CI:1.03-10.41,P=0.03)were independent risk factors for the occurrence of UPR(P<0.05).Conclusion Patients with operation duration>12 h or a previous history of free flap reconstruction in the head and neck have a higher risk of UPR during hospitalization.Close attention should be paid to the situation of patients within 24 h after surgery to prevent the occurrence of neck hematoma and venous crisis.

关 键 词：口腔颌面肿瘤 游离皮瓣修复重建术 非计划再次手术 危险因素 

分 类 号：R739.8[医药卫生—肿瘤]