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題名 | Risk Factors for Postoperative Pneumonia after Head and Neck Cancer Surgery with Free Flap Reconstruction=頭頸癌自由皮瓣重建手術後肺炎之危險因子分析 |
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作 者 | 游騰翔; 李俊達; | 書刊名 | 臺灣整形外科醫學會雜誌 |
卷期 | 27:4 2018.12[民107.12] |
頁次 | 頁243-253 |
分類號 | 416.21 |
關鍵詞 | 手術後肺炎; 術後併發症; 頭頸癌; 自由皮瓣重建; Postoperative pneumonia; Head and neck surgery; |
語文 | 英文(English) |
中文摘要 | 背景:手術後肺炎是一項常見的術後併發症,且會對病患造成不同程度之影響。頭頸部癌症自由皮瓣重建手術是一耗時耗力的手術。若發生手術後肺炎,常會增加病患於加護病房及一般病房之住院時間。目的及目標:這篇研究的主要目的在於確立頭頸癌自由皮瓣重建手術後肺炎之危險因子,次要目的在於分析這些危險因子是否會影響皮瓣之存活率。材料及方法:這是一個單一中心,回溯性的研究;分析大於20歲之成人個案,於2016.1.1至2016.12.31在花蓮慈濟醫院接受頭頸癌手術及自由皮瓣重建。主要指標為術後14天內之肺炎發生率,並以羅吉斯回歸對於手術後肺炎危險因子進行單變項及多變項分析。結果:在89位符合收案條件之病患中,有13位病患發生手術後肺炎,發生率為14.6%。研究的主要結果為術後限制臥床時間及術後輸血和手術後肺炎有相關性。對20位接受皮瓣搶救手術之病患進行分析;並沒有一項手術前後之危險因子,包含術後限制臥床時間,與皮瓣搶救手術及皮瓣活率相關。結論:較長的術後限制臥床時間及術後輸血與頭頸癌自由皮瓣重建之手術後肺炎呈正相關,而術後限制臥床時間的長短和皮瓣的搶救率及存活率並無關聯。 |
英文摘要 | Background: Postoperative pneumonia (POP) is a common complication that can lead to varying degrees of morbidity. In particular, POP after head and neck surgery is a concern of plastic surgeons because it often leads to longer intensive care unit or hospital stay. Aim and Objectives: The purpose of this study was to determine the preoperative and perioperative risk factors for POP during head and neck surgery. The secondary goal was to analyze if the factors associated with POP also related to poor flap outcome. Patients and methods: This was a single-center, retrospective study that collected the data of adult patients > 20 years old who underwent head and neck surgery with free flap reconstruction at Hualien Tzu Chi Hospital between January 1, 2016 and December 31, 2016. The primary endpoint was the incidence of pneumonia within 14 days after surgery. The factors associated with POP were analyzed using univariate and multivariate logistic regression. Results: Of the 89 cases that fulfilled the inclusion criteria of this study, 13 cases (14.6%) developed POP. Primary outcome multivariate analysis revealed that immobilization days and postoperative transfusion were significantly associated with POP. Analysis of the 20 cases that underwent flap salvage operation showed that there were no associated preoperative and perioperative factors, including immobilization days, that increased salvage rate. The outcomes of total and partial flap necrosis were seen in six and four cases, respectively. The factors associated with poor flap outcome were history of head and neck cancer operation and radiotherapy. Conclusions: Longer duration of immobilization and postoperative transfusion were positively associated with the incidence of POP after head and neck tumor surgery with free flap reconstruction. Moreover, the duration of immobilization was not associated with increased flap salvage rate and poor flap outcome. |
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