口腔颌面部游离组织瓣移植术后延迟拔除气管插管的回顾性研究

doi:10.19438/j.cjoms.2025.05.006

摘要/Abstract

摘要： 目的: 分析口腔颌面部肿瘤切除同期血管化游离组织瓣移植修复的患者术后延迟拔除气管插管的临床效果。方法: 选择2019年1月—2024年5月山东省立医院同一手术团队治疗的口腔颌面部肿瘤切除同期行血管化游离组织瓣修复的患者257例。收集患者的临床资料,分析术后并发症,采用R 4.3.3软件对可能影响患者术后带管时间的因素进行统计学分析。结果: 257例患者均经鼻腔气管插管全麻下手术,术后均未行预防性气管切开术,直接带经鼻腔气管插管转入重症医学科监护治疗,待患者气道梗阻风险解除后拔除气管插管。251例（97.67%）患者顺利一期拔除气管插管,平均带管天数为5.11天。术后出现并发症患者49例（19.07%）,其中,术后皮瓣危象5例（1.95%）,术后出血5例（1.95%）,肺部炎症24例（9.34%）,二次气管插管3例（1.17%）,延迟气管切开2例（0.78%）,无法脱机自动出院1例（0.39%）,术后谵妄9例（3.50%）,术区感染7例（2.72%）。病变的良恶性差异、恶性肿瘤部位差异对患者术后拔管时间的影响有统计学意义。结论: 口腔颌面部肿瘤切除联合游离组织瓣修复的患者,延迟拔除气管插管是一种安全有效的气道管理方式,为无法接受术后预防性气管切开的患者提供了另一种选择。

关键词: 气道管理, 口腔颌面部肿瘤切除, 游离组织瓣移植, 预防性气管切开, 延迟拔除气管插管

Abstract: PURPOSE: To evaluate the clinical efficacy of delayed tracheal extubation in oral and maxillofacial tumor resection with simultaneous vascularized free tissue flap transplantation and reconstruction. METHODS: Retrospective review was conducted on 257 patients treated by the same surgical team in Shandong Provincial Hospital between January 2019 and May 2024 for oral and maxillofacial tumor resection combined with vascularized free tissue flap transplantation. Clinical data of patients were collected, postoperative complications were analyzed, and the factors that might affect the postoperative catheter duration of patients were statistically analyzed by using R 4.3.3 software. RESULTS: All 257 patients underwent nasal tracheal intubation under general anesthesia. All postoperative patients with nasotracheal tube were transferred to the intensive care unit(ICU) instead of prophylactic tracheotomy. The nasotracheal tube was delay extubated when the risk of airway obstruction was relieved. A total of 251 patients (97.67%) delayed extubation successfully in the first stage,with an average intubation time was 5.11 days. There were 49 patients (19.07%) who had postoperative complications, including 5 flap vascular crisis, 5 hemorrhage (1.95%), 24 pulmonary inflammation (9.34%), 3 secondary tracheal intubation (1.17%), 2 delayed tracheotomy(0.78%), 1 automatic discharge (0.39%), 9 postoperative delirium (3.50%), 7 postoperative maxillofacial infection (2.72%). The period of postoperative extubation was significantly affected by the difference between benign and malignant lesions, as well as the difference in tumor anatomic locations. CONCLUSIONS: Delayed extubation is a safe and effective airway management strategy for patients who have undergone oral and maxillofacial tumor resection combined with vascularized free tissue flap transplantation, which provides an alternative option for patients who cannot accept postoperative prophylactic tracheotomy.

Key words: Airway management, Oral and maxillofacial tumor resection, Free flap transfer, Prophylactic tracheotomy, Delayed extubation

中图分类号:

R782.05

于连聘, 黄圣运, 刘俊杰, 张卫东, 郑培惠, 侯亚丽. 口腔颌面部游离组织瓣移植术后延迟拔除气管插管的回顾性研究[J]. 中国口腔颌面外科杂志, 2025, 23(5): 463-468.

Yu Lianpin, Huang Shengyun, Liu Junjie, Zhang Weidong, Zheng Peihui, Hou Yali. Retrospective study of delayed tracheal extubation after oral and maxillofacial free flap transplantation surgery[J]. China J Oral Maxillofac Surg, 2025, 23(5): 463-468.

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