老年头颈癌患者术后游离皮瓣并发症的发生率及危险因素分析

doi:10.19438/j.cjoms.2025.06.008

摘要/Abstract

摘要： 目的：探讨老年头颈癌患者术后游离皮瓣并发症的独立危险因素,为术前风险分层及个体化管理提供依据。方法：回顾性纳入2014年1月—2022年12月上海交通大学医学院附属第九人民医院收治的1 197例老年患者（≥60岁）,均接受全麻下头颈癌根治术联合游离皮瓣重建。采用单因素分析筛选皮瓣并发症的潜在危险因素,多因素logistic回归分析确定独立危险因素。结果：术后游离皮瓣并发症总发生率为 20.13%（241/1 197）。多因素logistic 回归显示,吸烟（OR=1.391,95%CI：1.008~1.921,P=0.045）、慢性阻塞性肺疾病（OR=1.912,95%CI：1.064~3.436,P=0.030）、营养不良[预后营养指数(PNI)≤47.81,OR=1.362,95%CI：1.009~1.838,P=0.043]、慢性心力衰竭（OR=1.988,95%CI：1.150~3.437,P=0.014）及手术时长延长（OR=1.123,95%CI：1.052~1.200,P<0.001）是术后皮瓣并发症的独立危险因素。结论：吸烟、慢性阻塞性肺疾病、营养不良、慢性心力衰竭及手术时长延长是老年头颈癌患者术后游离皮瓣并发症的独立危险因素,临床上需针对性加强术前干预（如戒烟、营养支持、基础病控制）及术中时间管理,以降低并发症风险。

关键词: 头颈癌, 游离皮瓣重建, 术后并发症, 独立危险因素, 老年患者

Abstract: PURPOSE: To explore the independent risk factors for postoperative free flap complications in elderly patients with head and neck cancer, and to provide a basis for preoperative risk stratification and individualized management. METHODS: A total of 1 197 elderly patients (≥60 years old) admitted to Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from January 2014 to December 2022 were retrospectively included. All patients underwent radical resection of head and neck cancer combined with free flap reconstruction under general anesthesia. Univariate analysis was used to screen potential risk factors for flap complications, and multivariate logistic regression analysis was performed to identify independent risk factors. RESULTS: The total incidence of postoperative free flap complications was 20.13% (241/1 197). Multivariate logistic regression showed that smoking (OR=1.391, 95%CI: 1.008-1.921, P=0.045), chronic obstructive pulmonary disease (COPD) (OR=1.912, 95%CI: 1.064-3.436, P=0.030), malnutrition [prognostic nutritional index(PNI) ≤47.81, OR=1.362, 95%CI: 1.009-1.838, P=0.043], chronic heart failure (OR=1.988, 95%CI: 1.150-3.437, P=0.014), and prolonged operation duration (OR=1.123, 95%CI: 1.052-1.200, P<0.001) were independent risk factors for postoperative flap complications. CONCLUSIONS: Smoking, COPD, malnutrition, chronic heart failure, and prolonged operation duration are independent risk factors for postoperative free flap complications in elderly patients with head and neck cancer. Clinically, targeted preoperative interventions (such as smoking cessation, nutritional support, and control of underlying diseases) and intraoperative time management should be strengthened to reduce the risk of complications.

Key words: Head and neck cancer, Free flap reconstruction, Postoperative complications, Independent risk factors, Elderly patients

中图分类号:

R739.8

沈龙, 龚澄霞, 董洁刚, 杨悦来, 孙宇, 孟露, 赵侃如. 老年头颈癌患者术后游离皮瓣并发症的发生率及危险因素分析[J]. 中国口腔颌面外科杂志, 2025, 23(6): 586-591.

Shen Long, Gong Chengxia, Dong Jiegang, Yang Yuelai, Sun Yu, Meng Lu, Zhao Kanru. The incidence and risk factors of free flap complications after head and neck cancer surgery in elderly patients[J]. China J Oral Maxillofac Surg, 2025, 23(6): 586-591.

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