头颈部肿瘤非计划再次手术的原因和影响因素分析

Comprehensive analysis of unplanned reoperations in head and neck neoplasms

目的探讨头颈部肿瘤患者发生非计划再次手术的原因和影响因素。方法回顾性分析2016年1月至2018年12月在中国医学科学院肿瘤医院经手术治疗的头颈部肿瘤患者的临床资料。结果头颈部肿瘤手术共15113例,其中非计划再次手术122例,发生率为0.81%,非计划再次手术主要集中在术后24 h内,出血(65.57%)、淋巴瘘(15.57%)、血管危象(9.84%)是主要原因。患者性别、手术部位、首次手术级别、切口级别、美国麻醉医师协会(ASA)分级与非计划再次手术的发生有关。首次手术部位为扁桃体(15.79%)、牙龈(8.93%)、口咽(8.33%)、下咽(4.79%)、舌部(3.17%)的患者发生非计划再次手术概率较高。非计划再次手术导致患者住院时间平均延长121.66%,住院费用平均增长99.35%。结论非计划再次手术提高医院运营成本和患者负担。要密切关注患者术后24 h内情况,重点防范出血、淋巴瘘和血管危象的发生。针对男性、高龄、手术级别高、手术切口级别高、ASA分级高的患者,尤其是手术部位为扁桃体、牙龈、口咽、下咽、舌部的患者,要充分做好术前评估和准备工作。

Objective To investigate the causes and influencing factors of unplanned reoperation in head and neck neoplasms.Methods A retrospective analysis was conducted on the clinical data of the operation treated patients with head and neck neoplasm in Cancer Hospital Chinese Academy of Medical Sciences from 2016 to 2018.Results Among 15113 cases of head and neck neoplasms,122 cases underwent unplanned reoperation,with an incidence of 0.81%.Unplanned reoperation mainly occurred within 24 hours after operation.The main causes of reoperation were bleeding(65.57%),lymphatic fistula(15.57%)and vascular crisis(9.84%).Sex,surgical site,grade of the first operation,grade of incision and grade of American Society of Anesthesiologists were associated with unplanned reoperations.The first surgical sites with higher probability of unplanned reoperation were tonsils(15.79%),gingiva(8.93%),oropharynx(8.33%),hypopharynx(4.79%)and tongue(3.17%),respectively.Unplanned reoperation resulted in an average expand of 121.66%in hospitalization time and 99.35%in hospitalization expenses.Conclusions Unplanned reoperation increases hospital operating costs and patients′burden.We should pay close attention to the situation of patients within 24 hours after operation,and focus on preventing bleeding,lymphatic fistula and vascular crisis.We should make adequate preoperative evaluation and preparation for elderly male patients with high surgical grade,surgical incision and ASA grade,especially for the patients whose surgical sites were tonsil,gingiva,oropharynx,hypopharynx and tongue.