Üstün Galip Gencay, Aksu Ali Emre, Uzun Hakan, Bitik Ozan
Department of Plastic Surgery, Hacettepe University Hospitals, Ankara, Turkey.
Microsurgery. 2017 Jul;37(5):442-450. doi: 10.1002/micr.30156. Epub 2017 Mar 20.
Prolonged mean life expectancy gives rise to a more populated and older patient group. With increasing number of cases during the past decades, older patients are regarded as candidates for microsurgical interventions. Whether advanced patient age is an independent risk factor for microsurgical reconstruction is still an ongoing matter of debate.
The Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, CINAHL and EMBASE databases were screened for combination of the key words "elderly", "geriatric", "advanced age", "free flap", "microsurgery", free tissue transfer" by using time limits between 1989 and 2015.
According to results of the meta-analysis, there was no significant difference in the flap success rates(P =.39, CI = 0.848 to 2.329) and surgical complication rates (P = .83, CI = 0.792 to 1.163) between the young and elderly patient groups. However, the systemic complication rates(P = .02, CI = 1.468 to 3.572), preoperative ASA scores(P < .0001, CI = 0.342 to 1.078), and mortality rates (P = .03, CI = 2.636 to 9.055) were found to be significantly higher in the elderly patients.
Although an increased rate of systemic complications and mortality has been associated with advanced age, our study results showed no significant difference between the flap success rates and surgical complications. A successful reduction in systemic complications would bring the risk level of reconstructive microsurgical interventions of the elderly patient group to the level of the young patient group. © 2017 Wiley Periodicals, Inc. Microsurgery 37:442-450, 2017.
平均预期寿命的延长导致患者群体数量增加且年龄更大。在过去几十年中，随着病例数量的增加，老年患者被视为显微外科手术干预的对象。高龄是否是显微外科重建的独立危险因素仍是一个尚无定论的争议话题。
通过使用1989年至2015年的时间限制，在Cochrane对照试验中央注册库、PubMed、MEDLINE、CINAHL和EMBASE数据库中筛选关键词“老年人”“老年病”“高龄”“游离皮瓣”“显微外科”“游离组织移植”的组合。
根据荟萃分析结果，年轻和老年患者组之间的皮瓣成功率（P = 0.39，CI = 0.848至2.329）和手术并发症发生率（P = 0.83，CI = 0.792至1.163）没有显著差异。然而，发现老年患者的全身并发症发生率（P = 0.02，CI = 1.468至3.572）、术前ASA评分（P < 0.0001，CI = 0.3俯弧碘旧鄢搅碉些冬氓42至1.078）和死亡率（P = 0.03，CI = 2.636至9.055）显著更高。
尽管全身并发症发生率和死亡率的增加与高龄有关，但我们的研究结果显示皮瓣成功率和手术并发症之间没有显著差异。成功降低全身并发症将使老年患者组的重建显微外科手术干预风险水平降至年轻患者组的水平。© 2017威利期刊公司。显微外科37:442 - 450，2017。
