口腔颌面肿瘤性缺损股前外侧皮瓣修复的并发症危险因素分析及其对护理的启示

Use of Anterolateral Thigh Flap for Reconstruction of Oral and Maxillofacial Defects: Risk Factors for Complications and Nursing Implications

目的:回顾分析口腔颌面部缺损股前外侧皮瓣修复术术后并发症相关危险因素及其对护理对策的提示。方法:纳入2014年1月至2016年12月于我科就诊的口腔颌面部缺损并接受股前外侧皮瓣修复术的患者进行回顾性分析,总结术后并发症的数量、类型。结果:本次调查的311例接受股前外侧皮瓣修复术的患者中,46例出现术后并发症。气管切开与未接受气管切开的患者相比,总体并发症、皮瓣并发症、非皮瓣并发症的发生率差异具有统计学意义。良性肿瘤与恶性肿瘤患者间皮瓣相关并发症的发生率差异有统计学意义。多因素logistic回归分析显示:气管切开患者相对于未接受气管切开患者而言,总体并发症、皮瓣并发症、以及非皮瓣并发症发生风险增加。复发性肿瘤患者相对原发肿瘤患者,总体并发症及皮瓣并发症发生风险增加。而年龄>60相对≤60岁的患者在总体并发症上具有更高的发生风险。结论:针对上述各种危险因素,掌握术后并发症相对应的护理措施,针对性的术后护理及观察对于有效降低术后并发症有着重要的意义。

Objective: To investigate the postoperative complications of the reconstructive surgery for oral and maxillofacial defects by using anterolateral thigh flap(ALTF), and to analyze the risk factors of the complications and the nursing strategy for patients. Methods: Patients with tumors in oral and maxillofacial region who underwent surgical operation in our department from January 2014 to December 2016 were enrolled in this retrospective study. Number and type of and risk factors for postoperative complications were analyzed. Results: A total of 311 patients underwent the reconstructive surgery for oral and maxillofacial defects by using ALTF, and 46 patients had postoperative complications. There was a significantly increased risk of postoperative complications(including flap complications and non-flap complications) in patients who underwent tracheotomy compared with those without tracheotomy. A statistically significant difference in the incidence of postoperative flap-specific complications was observed between patients with malignant tumors and those with benign tumors. Multivariable Logistic regression model showed that there was an increased risk of postoperative complications(including flap complications and non-flap complications) in patients undergoing tracheotomy. In addition, recurrent tumor patients, compared to primary tumor patients, suffered from a higher incidence of flap-specific complications. And the incidence of complications in the above 60-year-old patients was higher than that in the below 60-year-old patients. Conclusion: In the light of the above-mentioned risk factors, it is of great importance to master nursing measures to combat complications. Targeted postoperative care and observation can reduce postoperative complications and subsequent effects.