头颈肿瘤游离皮瓣修复术后高凝状态的影响因素分析

Factors influencing postoperative hypercoagulability of free flap reconstruction for head and neck tumor

背景与目的:游离皮瓣已成为头颈肿瘤修复术后的主要修复方式,血管危象易引起皮瓣坏死,而高凝状态是引起血管危象的主要原因。通过探讨头颈肿瘤游离皮瓣修复术后高凝状态的影响因素,旨在为高凝状态的防治提供参考依据。方法:回顾性分析福建医科大学附属第二医院耳鼻咽喉科2017年4月—2020年7月收治的243例头颈肿瘤手术且行游离皮瓣修复患者的临床资料,根据术后是否发生高凝状态分为高凝组和非高凝组,统计分析术后高凝状态的发生率及相关影响因素。结果:243例研究对象中,128例出现术后高凝状态,术后高凝状态的发生率为52.7%(128/243),其中术后凝血指标两项异常为73.4%(94/128),三项异常为21.1%(27/128),四项异常为5.5%(7/128)。单因素分析结果显示,性别、年龄、酗酒、糖尿病、肿瘤分期、修复术式、术中出血量、术中输血量、手术时间、术后白细胞水平、术后甘油三脂水平、术后高密度脂蛋白、术后血Ca~(2+)水平为术后高凝状态的可能影响因素(P<0.05);多因素logistic回归分析结果显示,糖尿病(OR=1.823,95%CI:1.246~4.719)、肿瘤分期(OR=2.155,95%CI:1.126~4.126)、术后白细胞水平(OR=1.346,95%CI:1.068~2.979)、术后甘油三脂水平(OR=3.583,95%CI:1.539~8.343)是术后高凝状态的独立影响因素。结论:术后高凝状态在头颈肿瘤游离皮瓣修复术后较为常见,对于糖尿病、肿瘤晚期、术后白细胞高、甘油三脂高等高危因素的患者,应予以积极的综合性干预措施。

Background and purpose:Free flap has become the main way of reconstruction after surgery for head and neck tumor.Vascular crisis is easy to cause skin flap necrosis,and hypercoagulability is the main cause of vascular crisis.This study explored the factors influencing postoperative hypercoagulability of free flap reconstruction for head and neck tumor,and provided reference for the prevention and treatment of hypercoagulability.Methods:A retrospective analysis was conducted according to the medical records of 243 patients admitted to Department of Otolaryngology,Second Affiliated Hospital of Fujian Medical University from Apr.2017 to Jul.2020 who underwent free flap reconstruction for head and neck tumor.The patients were divided into the hypercoagulable group and the non-hypercoagulable group according to whether postoperative hypercoagulable state occurred,and the incidence of postoperative hypercoagulable state and related influencing factors were statistically analyzed.Results:Among the 243 patients,128 patients had postoperative hypercoagulability,and the incidence was 52.7%(128/243),including 73.4%(94/128)of two postoperative coagulation abnormalities,21.1%(27/128)of three abnormalities and 5.5%(7/128)of four abnormalities.Results of single factor analysis showed that gender,age,alcoholism,diabetes,tumor stage,surgical repair,intraoperative blood loss,intraoperative blood transfusion,operative time,postoperative leukocyte,postoperative triglyceride,postoperative high-density lipoprotein and postoperative Ca2+were the possible influencing factors of postoperative hypercoagulability(all P<0.05).Multivariate factor logistic regression analysis showed that diabetes mellitus(OR=1.823,95%CI:1.246-4.719),tumor stage(OR=2.155,95%CI:1.126-4.126),postoperative leukocyte(OR=1.346,95%CI:1.068-2.979)and postoperative triglyceride(OR=3.583,95%CI:1.539-8.343)were independent risk factors of postoperative hypercoagulability.Conclusion:Postoperative hypercoagulability of free flap reconstruction for head and neck tumor is more common.For patients with risk factors of diabetes,advanced tumor stage,postoperative high leukocyte and high triglyceride,comprehensive intervention measures should be taken actively.