4种评分系统判断口腔癌患者术后气管切开需求的准确性评价

doi:10.19438/j.cjoms.2022.02.005

摘要/Abstract

摘要： 目的:比较Kruse评分、Cameron评分、CASST评分、TRACHY评分判断口腔癌患者术后气管切开需求的效能。方法:回顾性分析2017年12月—2021年7月南京医科大学第一附属医院口腔颌面外科收治的口腔癌患者的临床资料。将临床资料转换为各评分系统得分,根据推荐阈值进行计算评估。绘制受试者工作特征曲线（ROC）,根据约登指数调整最佳阈值以重新评估,使用曲线下面积（AUC）比较4种评分的预测效能。采用SPSS 26.0软件包、MedCalc 20.0统计软件对数据进行统计学分析。结果:共纳入口腔癌患者235例,气管切开率为9.8%（23/235）。所有患者术后未行紧急外科气道管理,均在病情稳定后出院。所有评分调整前、后均显示较差的阳性预测值（0.28~0.4/0.19~0.45）,敏感度为0.39~0.91/0.87~0.91,特异度为0.75~0.93/0.61~0.88。AUC从大到小依次为Cameron、TRACHY、CASST、Kruse评分,其中Cameron与Kruse评分（Z=2.014,P<0.05）、Cameron评分与CASST评分之间（Z=1.996,P<0.05）有显著差异。结论:4种评分系统在判断口腔癌患者术后气管切开需求方面存在不足,可能导致更高的气管切开率。

关键词: 口腔癌, 气管切开术, 评分系统

Abstract: PUPPOSE: This study was to assess and compare the predictive value of Kruse, Cameron, CASST and TRACHY tracheostomy scoring system on the need for tracheostomy in patients with oral cancers. METHODS: A retrospective analysis was conducted of clinical data of patients with oral cancers admitted to the Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Nanjing Medical University from December 2017 to July 2021. The clinical data were converted into total score of each scoring system, and the calculation and assessment were examined based on the recommended threshold. Receiver operating characteristic curve(ROC) analysis was used to examine the optimal threshold to reassess according to Youden index. The predictive value was compared by applying the area under receiver operating curve (AUC). The data were analyzed using SPSS 26.0 software package and MedCalc 20.0 software. RESULTS: Two hundred and thirty five cases were included in this retrospective study and the rate of tracheotomy rate was 9.8%(23/235). No emergency surgical airway management was performed after operation, and all patients were discharged with stable condition. All score systems performed poor positive predictive value before or after adjustment (0.28-0.4/0.19-0.45), the sensitivity was 0.39-0.91/0.87-0.91, the specificity was 0.75-0.93/0.61-0.88. AUC from greater to smaller was arranged as Cameron, TRACHY, CASST, Kruse tracheostomy scoring systems. There was significant difference of AUC between Cameron and Kruse scoring system(Z=2.014,P<0.05), Cameron and CASST scoring system (Z=1.996,P<0.05). CONCLUSIONS: Instead of effectively judging the need for tracheotomy, these four scoring systems may lead to a higher tracheostomy rate.

Key words: Oral cancer, Tracheostomy, Scoring system

中图分类号:

R782.05

朱博文, 庄海, 毛秋怡, 卜寿山. 4种评分系统判断口腔癌患者术后气管切开需求的准确性评价[J]. 中国口腔颌面外科杂志, 2022, 20(2): 129-134.

ZHU Bo-wen, ZHUANG Hai, Mao Qiu-yi, BU Shou-shan. Predictive value of four scoring systems on judging the need for tracheostomy in patients with oral cancers[J]. China J Oral Maxillofac Surg, 2022, 20(2): 129-134.

参考文献

[1] Mishra S, Bhatnagar S, Jha RR, et al.Airway management of patients undergoing oral cancer surgery: a retrospective study[J]. Eur J Anaesthesiol, 2005, 22(7): 510-514.
[2] Meerwein C, Pézier TF, Beck-Schimmer B, et al.Airway management in head and neck cancer patients undergoing microvascular free tissue transfer: delayed extubation as an alternative to routine tracheotomy[J]. Swiss Med Wkly, 2014, 144: w13941.
[3] Yeung JK, Harrop R, McCreary O, et al. Delayed mobilization after microsurgical reconstruction: an independent risk factor for pneumonia[J]. Laryngoscope, 2013, 123(12): 2996-3000.
[4] Marsh M, Elliott S, Anand R, et al.Early postoperative care for free flap head & neck reconstructive surgery-a national survey of practice[J]. Br J Oral Maxillofac Surg, 2009, 47(3): 182-185.
[5] Crosher R, Baldie C, Mitchell R.Selective use of tracheostomy in surgery for head and neck cancer: an audit[J]. Br J Oral Maxillofac Surg, 1997, 35(1): 43-45.
[6] Coyle MJ, Shrimpton A, Perkins C, et al.First do no harm: should routine tracheostomy after oral and maxillofacial oncological operations be abandoned?[J]. Br J Oral Maxillofac Surg, 2012, 50(8): 732-735.
[7] Moubayed SP, Barker DA, Razfar A, et al.Microvascular reconstruction of segmental mandibular defects without tracheostomy[J]. Otolaryngol Head Neck Surg, 2015, 152(2): 250-254.
[8] Myatra SN, Gupta S, D’Cruz AK, et al. Identification of patients for a delayed extubation strategy versus elective tracheostomy for postoperative airway management in major oral cancer surgery: a prospective observational study in seven hundred and twenty patients[J]. Oral Oncol, 2021, 121: 105502.
[9] Coyle MJ, Tyrrell R, Godden A, et al.Replacing tracheostomy with overnight intubation to manage the airway in head and neck oncology patients: towards an improved recovery[J]. Br J Oral Maxillofac Surg, 2013, 51(6): 493-496.
[10] Batra TK, Tilak MR, Pai E, et al.Increased tracheostomy rates in head and neck cancer surgery during the COVID-19 pandemic[J]. Int J Oral Maxillofac Surg, 2021, 50(8): 989-993.
[11] Singh T, Sankla P, Smith G.Tracheostomy or delayed extubation after maxillofacial free-flap reconstruction?[J]. Br J Oral Maxillofac Surg, 2016, 54(8): 878-882.
[12] Patel RS, McCluskey SA, Goldstein DP, et al. Clinicopathologic and therapeutic risk factors for perioperative complications and prolonged hospital stay in free flap reconstruction of the head and neck[J]. Head Neck, 2010, 32(10): 1345-1353.
[13] Nagarkar R, Kokane G, Wagh A, et al.Airway management techniques in head and neck cancer surgeries: a retrospective analysis[J]. Oral Maxillofac Surg, 2019, 23(3): 311-315.
[14] Mehanna H, Hardman JC, Shenson JA, et al.Recommendations for head and neck surgical oncology practice in a setting of acute severe resource constraint during the COVID-19 pandemic: an international consensus[J]. Lancet Oncol, 2020, 21(7): e350-e359.
[15] 王延, 蒋通辉, 庄海, 等. 术前肠内营养支持治疗在口腔鳞癌患者加速康复中的应用[J]. 中国口腔颌面外科杂志, 2020, 18(2): 122-126.
[16] Fattahi T, Vega L, Fernandes R, et al.Our experience with 171 open tracheostomies[J]. J Oral Maxillofac Surg, 2012, 70(7): 1699-1702.
[17] Halfpenny W, McGurk M. Analysis of tracheostomy-associated morbidity after operations for head and neck cancer[J]. Br J Oral Maxillofac Surg, 2000, 38(5): 509-512.
[18] Petrar S, Bartlett C, Hart RD, et al.Pulmonary complications after major head and neck surgery: a retrospective cohort study[J]. Laryngoscope, 2012, 122(5): 1057-1061.
[19] 朱莹, 徐辉, 朱也森, 等. 影响颌面肿瘤手术后气道管理的手术因素分析[J]. 组织工程与重建外科杂志, 2011, 7(5): 286-289, 294.
[20] Cameron M, Corner A, Diba A, et al.Development of a tracheostomy scoring system to guide airway management after major head and neck surgery[J]. Int J Oral Maxillofac Surg, 2009, 38(8): 846-849.
[21] Cai TY, Zhang WB, Yu Y, et al.Scoring system for selective tracheostomy in head and neck surgery with free flap reconstruction[J]. Head Neck, 2020, 42(3): 476-484.
[22] Gupta K, Mandlik D, Patel D, et al.Clinical assessment scoring system for tracheostomy (CASST) criterion: objective criteria to predict pre-operatively the need for a tracheostomy in head and neck malignancies[J]. J Craniomaxillofac Surg, 2016, 44(9): 1310-1313.
[23] Kim YH, Kim MY, Kim CH.Elective tracheostomy scoring system for severe oral disease patients[J]. J Korean Assoc Oral Maxillofac Surg, 2014, 40(5): 211-219.
[24] Kruse-Lösler B, Langer E, Reich A, et al.Score system for elective tracheotomy in major head and neck tumour surgery[J]. Acta Anaesthesiol Scand, 2005, 49(5): 654-659.
[25] Mohamedbhai H, Ali S, Dimasi I, et al.TRACHY score: a simple and effective guide to management of the airway in head and neck cancer[J]. Br J Oral Maxillofac Surg, 2018, 56(8): 709-714.
[26] Leiser Y, Barak M, Ghantous Y, et al.Indications for elective tracheostomy in reconstructive surgery in patients with oral cancer[J]. J Craniofac Surg, 2017, 28(1): e18-e22.
[27] Huang SH, O’Sullivan B. Overview of the 8th Edition TNM classification for head and neck cancer[J]. Curr Treat Options Oncol, 2017, 18(7): 40-53.
[28] Lee HJ, Kim JW, Choi SY, et al.The evaluation of a scoring system in airway management after oral cancer surgery[J]. Maxillofac Plast Reconstr Surg, 2015, 37(1): 19-26.
[29] Janik S, Brkic FF, Grasl S, et al.Tracheostomy in bilateral neck dissection: comparison of three tracheostomy scoring systems[J]. Laryngoscope, 2020, 130(11): E580-E586.
[30] Benatar-Haserfaty J, Picón-Molina M, Meléndez-Salinas D A, et al. Usefulness of the Cameron tracheostomy scoring system after oral tumor surgery[J]. Rev Esp Anestesiol Reanim, 2014, 61(7): 369-374.
[31] Schmutz A, Dieterich R, Kalbhenn J, et al.Protocol based evaluation for feasibility of extubation compared to clinical scoring systems after major oral cancer surgery safely reduces the need for tracheostomy: a retrospective cohort study[J]. BMC Anesthesiol, 2018, 18(1): 43-53.