皮肤软组织扩张术埋置注液期并发症危险因素研究

Risk Factors of Complications after Tissue Expasion

目的:回顾性分析既往就诊病例资料,探寻软组织扩张术埋置注液期并发症发生的独立危险因素,为降低并发症发生率提供指导。方法:收集并统计西京医院整形外科2003年1月-2012年12月行皮肤软组织扩张术患者的临床资料,行单因素Logistic回归分析进行比较,寻找潜在危险因素,将P<0.1的变量引入多因素Logistic回归分析模型,进行Backward Conditional逐步回归分析,P<0.05视为独立危险因素。结果:共2 056人次3 382枚扩张器纳入本课题,埋置注液期共439枚扩张器产生并发症,并发症发生率为13.0%,各类并发症中以感染与扩张器外露居多,分别为177枚(5.2%)、175枚(5.2%),其后分别为血肿100枚(3.0%),皮肤坏死83枚(2.5%),切口裂开24枚(0.7%),各类扩张器原因需处理者19枚(0.6%),其他特殊类型并发症为面神经功能障碍者2例。经统计分析发现扩张器共置数、扩张器埋置部位与扩张器容积是并发症发生的独立危险因素。结论:并发症的独立危险因素为扩张器共置数、扩张器埋置部位与扩张器容积,单次手术扩张器埋置数越多、手术部位为面颈部及扩张器扩张容积过大时,软组织扩张术发生并发症的可能性越大,本研究对降低并发症发生具有重要的临床参考意义。

Objective To explore the independent risk factors of complications occurring during the burial period of soft tissue expansion,and to provide guidance for reducing the incidence of complications.Methods Medical Records of patients who were undergoing the soft tissue expansion at the department of plastic surgery of Xijing Hospital from January 2003 to December 2012 was collected.Univariate associations with complictions were measured by Logistic regression and represented as odds ratios.The P-value less than 0.1 was identified the potential risk factor.Multivariate Logistic regression was used to calculate odds ratios for risk factors of complications.Independent risk factors were identified if the P-value was less than 0.05.Results A total of 3382 expanders in 2056 patients were included in the study.The overall complication rate of tissue expansion was 13.0%in 439 expanders.The most common complications were infection(5.2%)and expander exposure(5.2%),followed by hematoma(3.0%),cutaneous necrosis(2.5%),wound dehiscence(0.7%),implant leak and others.Multivariate Logistic regression found that numbers of expander implanted,operative site and volume of expander were independent risk factors of complications.Conclusion Independent risk factors of complications were numbers of expander implanted,operative site and volume of expander.The more numbers of expander implanted,the operative site being facial part and cervicalregion and the bigger volume of exdander,the more possibility complications occurred.The result is important to instruct clinical work and reduce the incidence of complications.