口腔颌面部恶性肿瘤术后手术部位感染因素分析
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摘要
目的分析口腔颌面部恶性肿瘤患者术后手术部位感染的相关因素。方法采用回顾性研究方法,将240例口腔颌面部恶性肿瘤手术治疗患者纳入研究,统计术后手术部位感染发生率、肿瘤分布部位,根据是否发生感染分为感染组和非感染组;将术前血清白蛋白水平、术前牙结石情况、手术方式、术中是否使用抗生素、术中出血量、手术时长、置管时长、住院时长、术后放置引流管情况及转入重症加强护理病房(ICU)时长考虑为可能影响术后术区感染的因素,对比感染组与非感染组患者上述指标,进行单因素分析。将单因素分析发现可能相关的因素(P<0.05)纳入logistic回归分析,找出独立危险因素。结果舌癌患者术后手术部位感染率最高,其次为颊癌、唇癌、牙龈癌,而腭癌无感染发生,P <0.05。通过对比非感染组和感染组单因素分析发现感染组患者术前血清白蛋白≤35g/L、术前牙周结石Ⅲ度、术式Ⅲ(扩大切除+颈淋巴结清扫+皮瓣修复术)、术中使用抗生素、置管时间≤24h、住院时间>18d、术后放置引流管的百分率均较非感染组高,差异均有统计学意义(P<0.05)。两组在术中出血量、手术时长、转入ICU时长比较差异均无统计学意义(P>0.05)。多因素logistic回归分析发现导致患者术后手术部位感染的独立危险因素包括:术前牙周结石Ⅲ度(OR=7.149,P=0.014)、术前血清白蛋白≤35g/L(OR=0.059,P=0.034)、术式Ⅲ(OR=4.135,P=0.024)、住院时间>18d(OR=24.845,P=0.009)。结论研究发现术前牙周结石Ⅲ度、术前血清白蛋白值≤35g/L、术式Ⅲ、住院时间>18d是口腔颌面部恶性肿瘤患者术后手术部位感染的独立危险因素,且感染多发生在舌癌患者中,应针对具备上述特征的患者重点预防术后术区感染。
Objective To analyze the factors associated with postoperative surgical site infection(SSI) in patients with oral and maxillofacial malignancy. Methods A retrospective study was performed on 240 patients after surgical treatment of oral and maxillofacial malignancies. The incidence of postoperative SSI was calculated in terms of the location of tumor. Preoperative serum albumin level, preoperative periodontal calculus, surgical approach, intraoperative antibiotic use, intraoperative blood loss, length of surgery, duration of indwelling catheter, length of hospital stay, postoperative drainage tubes, and length of ICU stay were considered as potential risk factors for SSI in patients with oral and maxillofacial malignancy. These factors were compared between the patients with SSI and those without SSI by univariate analysis. The significant factors identified by univariate analysis(P<0.05) were included in multivariate logistic regression analysis to identify the independent risk factors. Results The highest incidence of SSI was found in patients with tongue cancer, followed by patients with carcinoma of buccal mucosa, carcinoma of lip, and carcinoma of gingiva. No infection was found in the patients with carcinoma of palate(P<0.05). Univariate analysis identifid that preoperative serum albumin level ≤ 35 g/L, preoperative periodontal calculus level 3, surgical approach III(extended resection + cervical lymph node dissection + flap repair), intraoperative use of antibiotics, duration ofindwelling catheter ≤ 24 h, length of hospital stay >18 days, postoperative drainage tube were significant factors of SSI(P<0.05). There were no statistically significant differences between the non-infected group and the infected group in intraoperative blood loss, duration of surgery and ICU stay(P>0.05). Multivariate logistic regression analysis found that preoperative periodontal calculus level 3(OR=7.149, P=0.014), preoperative serum albumin level ≤ 35 g/L(OR = 0.059, P=0.034), surgical approach III(OR=4.135, P=0.024), hospital stay >18 days(OR=24.845, P=0.009) were the independent risk factors for postoperative SSI in patients with oral and maxillofacial malignancy. Conclusions Preoperative periodontal calculus level 3, preoperative serum albumin level ≤ 35 g/L, surgical approach III, and hospital stay >18 days are independent risk factors for SSI in patients with oral and maxillofacial malignancy. Such SSI is relatively more prevalent in patients with tongue cancer. Corresponding measures should be taken for prevention of postoperative SSI in such patients.
Objective To analyze the factors associated with postoperative surgical site infection(SSI) in patients with oral and maxillofacial malignancy. Methods A retrospective study was performed on 240 patients after surgical treatment of oral and maxillofacial malignancies. The incidence of postoperative SSI was calculated in terms of the location of tumor. Preoperative serum albumin level, preoperative periodontal calculus, surgical approach, intraoperative antibiotic use, intraoperative blood loss, length of surgery, duration of indwelling catheter, length of hospital stay, postoperative drainage tubes, and length of ICU stay were considered as potential risk factors for SSI in patients with oral and maxillofacial malignancy. These factors were compared between the patients with SSI and those without SSI by univariate analysis. The significant factors identified by univariate analysis(P<0.05) were included in multivariate logistic regression analysis to identify the independent risk factors. Results The highest incidence of SSI was found in patients with tongue cancer, followed by patients with carcinoma of buccal mucosa, carcinoma of lip, and carcinoma of gingiva. No infection was found in the patients with carcinoma of palate(P<0.05). Univariate analysis identifid that preoperative serum albumin level ≤ 35 g/L, preoperative periodontal calculus level 3, surgical approach III(extended resection + cervical lymph node dissection + flap repair), intraoperative use of antibiotics, duration ofindwelling catheter ≤ 24 h, length of hospital stay >18 days, postoperative drainage tube were significant factors of SSI(P<0.05). There were no statistically significant differences between the non-infected group and the infected group in intraoperative blood loss, duration of surgery and ICU stay(P>0.05). Multivariate logistic regression analysis found that preoperative periodontal calculus level 3(OR=7.149, P=0.014), preoperative serum albumin level ≤ 35 g/L(OR = 0.059, P=0.034), surgical approach III(OR=4.135, P=0.024), hospital stay >18 days(OR=24.845, P=0.009) were the independent risk factors for postoperative SSI in patients with oral and maxillofacial malignancy. Conclusions Preoperative periodontal calculus level 3, preoperative serum albumin level ≤ 35 g/L, surgical approach III, and hospital stay >18 days are independent risk factors for SSI in patients with oral and maxillofacial malignancy. Such SSI is relatively more prevalent in patients with tongue cancer. Corresponding measures should be taken for prevention of postoperative SSI in such patients.
引文
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[15]李月莉,高凤蕊,苏翠霞,等.影响口腔颌面部肿瘤术后口鼻腔相通患者恢复的原因分析及护理[J].河北医药,2015,37(12):1889-1891.
[16]胡婕,康红军,潘亮,等.妊娠合并肛周脓肿继发颌面部及纵隔感染临床报告并文献复习[J].临床误诊误治,2015,28(8):68-71.
[17]XIANG L,YU H,ZHANG X,et al.The versatile hippo pathway in oral-maxillofacial development and bone remodeling[J].Dev Biol,2018,440(2):53-63.
[18]张学伟,国美丽,王志兴,等.胸大肌皮瓣修复口腔颌面部大型缺损的临床体会[J].天津医药,2016,44(8):1026-1028.
[19]田忠奇,刘慧,胡露露,等.口腔颌面部恶性肿瘤患者术后术区感染危险因素分析[J].中国美容医学,2017,26(4):67-70.
[2]韩春,赵佳正,王可敬,等.口腔颌面部肿瘤外科钛板植入修复术后感染相关因素分析[J].浙江医学,2016,38(16):1345-1347.
[3]SUGAHARA K,KATSUMI Y,KOYACHI M,et al.Novel condylar repositioning method for 3D-printed models[J].Maxillofac Plast Reconstr Surg,2018,40(1):4.
[4]YANG S,JEE Y J,RYU D M.Reconstruction of large oroantral defects using a pedicled buccal fat pad[J].Maxillofac Plast Reconstr Surg,2018,40(1):7.
[5]万冠群,巫国辉,李小林,等.口腔颌面部肿瘤术后组织缺损修复的临床研究[J].中国美容医学,2015,24(6):24-27.
[6]曾晓燕,周维,张波.口腔颌面部间隙感染的临床分析[J].中华医院感染学杂志,2015,25(2):421-423.
[7]谭锡涛,池宇峰,王维,等.七叶皂苷钠治疗口腔颌面部术后肿胀的临床疗效观察[J].现代诊断与治疗,2015,26(21):4828-4830.
[8]戴昱,汤剑明,冯力,等.老年口腔颌面部手术患者感染特征及炎症反应观察[J].中国医师杂志,2017,19(11):1672-1675,1679.
[9]唐圣斌,雷邓,李玉峰.口腔颌面部损伤患者手术感染的相关因素分析与预防控制措施[J].中国美容医学,2018,27(8):124-126.
[10]吴立萌,蒋灿华,陈洁,等.口腔颌面部游离组织瓣移植受区血管制备困难时的处理[J].中华显微外科杂志,2016,39(2):114-118.
[11]杨文宾,李春洁,李龙江,等.口腔颌面部肿瘤患者术后感染细菌及耐药性分析[J].上海口腔医学,2015,24(5):584-588.
[12]郭家平,王翔.游离皮瓣移植术对口腔颌面部肿瘤切除术后缺损的修复研究[J].实用癌症杂志,2016,31(6):915-917.
[13]张华章,屠志琴,马惠芳.奥硝唑预防口腔颌面部术后感染的临床研究[J].中华医院感染学杂志,2015,25(23):5383-5384,5449.
[14]韩靓,陈卫贤,徐新江,等.血管化下段胸锁乳突肌皮瓣和颏下岛状皮瓣在头颈部肿瘤术后口腔颌面部缺损一期修复的应用[J].江苏医药,2017,43(2):118-121.
[15]李月莉,高凤蕊,苏翠霞,等.影响口腔颌面部肿瘤术后口鼻腔相通患者恢复的原因分析及护理[J].河北医药,2015,37(12):1889-1891.
[16]胡婕,康红军,潘亮,等.妊娠合并肛周脓肿继发颌面部及纵隔感染临床报告并文献复习[J].临床误诊误治,2015,28(8):68-71.
[17]XIANG L,YU H,ZHANG X,et al.The versatile hippo pathway in oral-maxillofacial development and bone remodeling[J].Dev Biol,2018,440(2):53-63.
[18]张学伟,国美丽,王志兴,等.胸大肌皮瓣修复口腔颌面部大型缺损的临床体会[J].天津医药,2016,44(8):1026-1028.
[19]田忠奇,刘慧,胡露露,等.口腔颌面部恶性肿瘤患者术后术区感染危险因素分析[J].中国美容医学,2017,26(4):67-70.