Department of Oral and Maxillofacial Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa-cho, Hachioji, Tokyo, 192-0032, Japan.
J Infect Chemother. 2010 Oct;16(5):334-9. doi: 10.1007/s10156-010-0108-y. Epub 2010 Sep 1.
The purpose of this study was to elucidate the risk factors for surgical-site infection (SSI) in oral cancer surgery with microvascular free-flap reconstructions and to propose appropriate SSI prevention. There were 276 patients who underwent oral cancer surgery with microvascular free-flap reconstructions at the Department of Oral and Maxillo-facial Surgery of Tokai University Hospital. The following variables were assessed as risk factors for SSIs: preoperative variables, including age, sex, body mass index, American Society of Anesthesiologist's (ASA) score, debilitating comorbidities, smoking, alcohol consumption, and Union Internationale Contre le Cancer Tumor Node Metastasis (UICC-TNM) classification; and operative variables, including duration of surgery, amount of blood loss, quantity of blood transfusion, tracheostomy, area of neck dissection, and previous chemotherapy. Statistical analysis was conducted to determine whether these factors constitute risks for SSI. Total overall SSI rate was 40.6% (112/276). When the occurrence of SSI was compared with the variables, ASA score (P=0.036), T stage (P=0.013), duration of surgery (P<0.001), blood loss (P=0.001), blood transfusion (P=0.01), and area of neck dissection (P=0.009) showed statistical significance. Analysis of these variables with a logistic regression model yielded ASA score and duration of surgery as significant factors. There was a tendency for blood loss and duration of surgery to increase in patients with a high T stage. A high T stage not only broadens the resection area and increases surgical invasiveness, it also increases susceptibility to dead space after microvascular reconstruction for oral cancer. Particular care in treating the wound should be taken in surgical patients with high T-stage scores. The occurrence of SSI is of particular concern in oral cancer surgery in patients with high ASA scores.
本研究旨在阐明伴有微血管游离皮瓣重建的口腔癌手术中外科部位感染（SSI）的危险因素，并提出适当的 SSI 预防措施。在东海大学医院口腔颌面外科，共有 276 例患者接受了伴有微血管游离皮瓣重建的口腔癌手术。评估了以下变量作为 SSI 的危险因素：术前变量，包括年龄、性别、体重指数、美国麻醉师协会（ASA）评分、衰弱合并症、吸烟、饮酒和国际抗癌联合会肿瘤淋巴结转移（UICC-TNM）分类；以及手术变量，包括手术持续时间、失血量、输血量、气管切开术、颈部清扫术面积和先前的化疗。进行了统计分析，以确定这些因素是否构成 SSI 的风险。总 SSI 发生率为 40.6%（112/276）。当将 SSI 的发生与变量进行比较时，ASA 评分（P=0.036）、T 分期（P=0.013）、手术持续时间（P<0.001）、失血量（P=0.001）、输血量（P=0.01）和颈部清扫术面积（P=0.009）具有统计学意义。使用逻辑回归模型对这些变量进行分析，结果表明 ASA 评分和手术持续时间是显著因素。T 期较高的患者失血量和手术持续时间有增加的趋势。T 期较高不仅扩大了切除面积，增加了手术侵袭性，而且还增加了口腔癌微血管重建后发生死腔的易感性。T 期评分较高的手术患者应特别注意伤口处理。ASA 评分较高的患者口腔癌手术中 SSI 的发生尤其令人关注。
