有關於頭頸癌術後皮瓣預後的危險因子之分析:單一醫學中心的經驗的多變量分析成果

Abstract

背景: 頭頸癌是國人惡性腫瘤死亡原因的第七名，目前頭頸癌的主要治療方式是以腫瘤切除合併頸部淋巴結廓清術再搭配皮瓣重建為主，而手術後醫師最為棘手的問題就是術後感染以及皮瓣失敗，這篇文章主要的目的是在探討頭頸癌術後皮瓣預後的危險因子之分析。 研究方法: 這是單一醫學中心回顧性病例世代研究，從2015年1月至2017年12月止總共有596位病人接受頭頸部癌症切除及皮瓣重建手術，首先將病人分成術後有沒有感染分為2組，之後再依據皮瓣有沒有失敗來分組，最後將術後感染的病人有沒有合併皮瓣失敗做再次分組，來做更深入的探討，所有病人的基本資料，癌症分期，術前抽血檢查，內科共病以及手術中的因子都完整的收集並分析，最後使用迴歸分析來找出可能的危險因子。 研究結果: 整體的術後感染率為18.29%，發現年齡及部分下顎骨切除是術後感染的危險因子，整體皮瓣的失敗率是4.3%，同時發現使用腓內側皮瓣重建及較長的手術時間(小時)是皮瓣失敗的危險因子，而在術後感染的病人同時合併皮瓣失敗的這組病人中，發現癌症部位是舌癌或是口腔底部癌症可能是保護因子，而較長的手術時間(小時)是危險因子。 結論: 由這次的研究發現，術後感染的危險因子是年齡，年齡越大越容易發生術後感染，皮瓣失敗的危險因子是使用腓內側皮瓣重建及較長的手術時間(小時)，在 術後感染的病人同時合併皮瓣失敗的這組病人中，發現癌症部位是舌癌或是口腔底部癌症可能是保護因子，而較長的手術時間(小時)是危險因子。

Background: Head and neck cancer remains one of the commonest cancers around the world. Risk factors of unfavorable outcome like surgical site infection (SSI) and flap loss are repeatedly reported without definitive conclusion. The aim of this study is to identify the potential influencing factors in patients undergoing head and neck reconstruction. Methods: This single center cohort study included 596 patients who underwent head and neck reconstruction between Jan. 2015 and Dec. 2017. Patients were divided first into two groups based on the development or not of SSI, and similar comparison was performed after separating the patients by flap loss. Furthermore, we also analyzed SSI patients with/without flap. The demographic and operative data were analyzed further with univariate and multivariate logistic regression. Result: The overall SSI rate was 18.29%, with the patient’s age being the independent risk factor (adjusted OR: 2.41, 65≤age<75, p < 0.004 and adjusted OR: 3.53, age≥75, p < 0.001). Segmental mandibulectomy was also the risk factor for SSI (adjusted OR: 1.81, p = 0.04). Gender, tumor characteristics, and comorbidities did not present statistical significance after multivariate analysis. The overall flap failure rate was 4.3%; usage of medial sural flap (adjusted OR: 6.89, p = 0.03) and prolonged operative time (hr) (adjusted OR: 1.38, p < 0.001) were shown to be important influencing factors in flap loss cohort. For SSI patients with/without flap loss, tongue/mouth floor in tumor site (adjusted OR: 0.08, p= 0.05) and operation time (hr) (adjusted OR: 1.58, p =0.001) showed significant difference in multivariate analysis. Conclusion: We found that the SSI incidence was associated with age, medial sural flap and operative time were significant in flap loss cohort, and operation time (hr) was the risk factor in SSI patients with/without flap loss group. Knowing the risk factors can help the operators to improve the flap outcome before head and neck reconstruction.