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題名 | Changes in Perioperative Serum Albumin Levels Predict Complications in Head and Neck Cancer Patients Undergoing Microsurgical Free-tissue Transfer=手術前後血液中白蛋白的變化於頭頸部腫瘤接受顯微手術自由皮瓣重建患者中其併發症之影響與預測 |
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作者 | 李哲雄; 朱庭儀; 吳至偉; 高煌凱; 黃祥富; 廖俊達; 曹中侃; | 書刊名 | 臺灣整形外科醫學會雜誌 |
卷期 | 26:3 2017.09[民106.09] |
頁次 | 頁293-308 |
分類號 | 416.21 |
關鍵詞 | 頭頸部腫瘤; 白蛋白; 自由皮瓣重建; 顯微手術; Head and neck reconstruction; Microsurgical free-tissue transfer; Albumin; Nutrition; |
語文 | 英文(English) |
中文摘要 | 背景:在頭頸部腫瘤病患中,營養不良之狀況常因進食困難或腫瘤造成的惡病質而造成血液白蛋白低下,常引起較高的死亡率及併發症。 目的與目標:藉由評估此族群病人於顯微重建手術前後之間的血液白蛋白值,來預測術後可能的併發症。材料與方法:在2014年3月至2014八月間,共177位病患術後住進顯微重建外科加護病房中,就當中62為頭頸部腫瘤無局部復發之患者接受腫瘤切除術後及顯微手術自由皮瓣重建之患者,以手術前後之間的血液白蛋白值的變化,腫瘤分期,原發疾病,手術方法,術中失血量,腫瘤切除與供皮區,以及術後三個月的併發症進行分析。結果:術前血液白蛋白值小於4.2 g/dl與內科併發症,手術併發症以及加總併發症有統計顯著差異(p值個別為0.028, 0.034 及0.001);術後一日血液白蛋白值小於3.0 g/dl與手術併發症以及加總併發症有統計顯著差異(p值個別為0.015及0.009);術前與術後一天血液白蛋白差異值大於0.9 g/dl與加總併發症有統計顯著差異(p值為0.028);術前與術後一天血液白蛋白變化值大於22%與加總併發症有統計顯著差異(p值為0.044)。在比較併發症與否的兩這族群之中,其原發疾病之間無顯著差異。結論:在頭頸部腫瘤之患者接受腫瘤切除術後及顯微手術自由皮瓣重建之患者中,藉由手術前後的血液白蛋白改變能夠有效地預測其併發症,尤其是在術前血液檢查白蛋白小於4.2g/dL之患者。 |
英文摘要 | Background: In head and neck cancer patients, poor oral intake and tumor-related cachexia contribute to poor nutrition and hypoalbuminemia, increasing overall morbidity and mortality. Aim and Objectives: We evaluated preoperative and postoperative albumin levels and perioperative changes to predict potential postoperative complications in this patient population. Materials and Methods: Between March 2014 and August 2014, 177 patients were admitted postoperatively to reconstructive micro-intensive care. Data of 62 primary head and neck cancer patients who underwent microsurgical free-tissue transfer without local recurrence were analyzed retrospectively. Perioperative albumin levels and changes, tumor status, underlying disease, operative method, intraoperative blood loss, primary tumor and donor dissection sites and complications within 3 months postoperatively were analyzed statistically. Results: Preoperative albumin levels <4.2 g/dL were significantly associated with medical, surgical and overall complications (p = 0.028, 0.034, and 0.001, respectively); postoperative day 1 albumin levels <3.0 g/dL were significantly associated with surgical and overall complications (p = 0.015 and 0.009, respectively); differences between preand postoperative albumin (delta-albumin) >0.9 g/dL were significantly associated with overall complications (p = 0.028), including delta-albumin ratios >0.22 (p = 0.044). No statistically significant differences were found in complications between groups with different underlying diseases. Conclusions: Differences between pre- and postoperative albumin levels reliably predict complications in head and neck cancer surgery patients could provide good predictive value for complication rates in these patients, especially in whose preoperative serum albumin level below 4.2g/dL. |
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