Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, USA.
Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, USA.
Lancet Oncol. 2017 Jul;18(7):e405-e413. doi: 10.1016/S1470-2045(17)30375-3.
Head and neck cancer surgery is often a complex multi-step procedure that includes major resections, vascularised tissue reconstruction, and extensive neck dissection. The upper aerodigestive tract mucosal lining is often disrupted during surgery, which requires the management of a clean-contaminated field and the need to reconstruct the mucosal lining. With bacterial contamination, surgical site infections (SSI) are a serious complication that can result in delayed wound healing, wound breakdown, fistula formation, and compromised tissue reconstruction. Methods to reduce SSI in patients with head and neck cancer have been intensely researched, yielding evolving and varied practice patterns. In this Review, we outline the data supporting perioperative antibiotic prophylaxis for clean-contaminated surgeries, which suggest that clindamycin is an inadequate prophylactic antibiotic therapy in the reduction of SSI, and that prolonged antibiotic courses have no established benefit. For salvage laryngectomy after radiotherapy with or without chemotherapy, reconstruction with vascularised tissue reduces the frequency and severity of pharyngocutaneous fistula formation. These evidence-based recommendations have been shown to reduce the chance of SSI after head and neck surgery.
头颈部癌症手术通常是一个复杂的多步骤过程，包括主要切除、血管化组织重建和广泛的颈部清扫。上呼吸道黏膜衬里在手术过程中经常被破坏，这需要管理一个清洁污染的领域，并需要重建黏膜衬里。由于细菌污染，手术部位感染（SSI）是一种严重的并发症，可能导致伤口愈合延迟、伤口破裂、瘘管形成和组织重建受损。为了减少头颈部癌症患者的 SSI，人们已经对其进行了深入研究，产生了不断发展和多样化的实践模式。在这篇综述中，我们概述了支持清洁污染手术围手术期抗生素预防的数据，这些数据表明克林霉素作为预防 SSI 的抗生素治疗是不充分的，并且延长抗生素疗程没有确定的益处。对于放疗加或不加化疗后的挽救性喉切除术，血管化组织重建可降低咽皮瘘形成的频率和严重程度。这些基于证据的建议已被证明可降低头颈部手术后 SSI 的机会。
