Analysis of Postoperative Bleeding and Risk Factors in Transoral Surgery of the Oropharynx
Analysis of Postoperative Bleeding and Risk Factors in Transoral Surgery of the Oropharynx
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DOI：
10.1001/jamaoto.2013.5097
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发表时间：
2013-11-01
影响因子：
7.8
通讯作者：
Walter, Logan C.
中科院分区：
文献类型：
--
作者：
Pollei, Taylor R.;Hinni, Michael L.;Walter, Logan C.
重要性随着口咽癌发病率的增加和经口手术技术的普及，术后出血及其相关危险因素值得评估。多中心回顾性病历回顾分析了906例经口手术治疗口咽癌患者的外科手术，1994年至2012年，护理，学术转诊中心。分析肿瘤分期、既往治疗、切除方法、经颈外动脉分支结扎与术后出血率和严重程度的关系。一种新的分类系统，分级出血事件为轻微，中间，重大，或严重的管理方法和相关的sequels.Results术后出血发生在5.4%的患者（49 906），其中67.3%（33 49）需要手术干预。重度出血事件非常罕见（1.1%的患者）。在15.6%的患者中进行了经颈外动脉系统血管结扎并进行了一期切除，接受结扎的患者与未接受结扎的患者在出血率或出血严重程度方面没有总体差异（分别为P = 0.21和P = 0.66）。T分期较高的患者更常进行血管结扎（P = .002）。在既往接受过治疗的患者中，如果血管被结扎，出血的严重程度会降低（P > 0.05）。T分期越高，出血率越高（P = 0.02）。出血率与激光（5.6%）和机器人（5.9%）口咽切除术（P = 0.80）之间相似;然而，T期肿瘤明显较高的患者采用激光与机器人技术治疗（P <0.001）。结论和相关性口咽癌经口切除术是安全的，严重危及生命的出血是罕见的。虽然经颅血管结扎并没有导致出血率的总体下降，但结扎有降低咽切除术后出血严重程度的趋势。我们建议对T分期较高的肿瘤、原发性扁桃体肿瘤和接受翻修手术的患者进行结扎。
IMPORTANCE With an increasing incidence of oropharyngeal carcinoma and prevalence of transoral surgical techniques, postoperative bleeding, with its associated risk factors, deserves evaluation.OBJECTIVE To classify and review postoropharyngectomy hemorrhage rates and associated risk factors.DESIGN, SETTING, AND PARTICIPANTS Single-institution, multicenter retrospective medical chart review analyzing surgical procedures in 906 patients treated with transoral surgery for oropharyngeal carcinoma at a tertiary care, academic referral center from 1994 to 2012. Tumor stage, previous treatment, resection method, and transcervical external carotid branch ligation were analyzed in relationship to postoperative hemorrhage rate, and severity. A novel classification system was created, grading bleeding episodes as minor, intermediate, major, or severe based on management method and related sequelae.RESULTS Postoperative bleeding occurred in 5.4% of patients (49 of 906) with 67.3% of these (33 of 49) requiring operative intervention. Severe bleeding episodes were very rare (1.1% of patients). Transcervical external carotid system vessel ligation was performed with the primary resection in 15.6% of patients with no overall difference in bleeding rate or severity of bleeding in patients who underwent ligation vs those who did not (P = .21 and P = .66, respectively). Vessel ligation was performed more frequently in patients with a higher T stage (P = .002). In previously treated patients, severity of bleeding was decreased if vessels were ligated (P > .05). Higher T-stage tumors had a higher bleeding rate (P = .02). Bleeding rates were similar between those treated with laser (5.6%) and robotic (5.9%) oropharyngectomy (P = .80); however, patients with significantly higher T-stage tumors were treated with laser vs robot techniques (P < .001).CONCLUSIONS AND RELEVANCE Transoral resection of oropharyngeal carcinoma is safe, and severe life-threatening hemorrhage is rare. Although transcervical vessel ligation did not result in an overall decrease in bleeding rate, there is a trend toward reduced postoropharyngectomy bleeding severity with ligation. We recommend ligation for higher T-stage tumors, primary tonsil tumors, and patients undergoing revision surgery.