Suzuki Sayaka, Yasunaga Hideo, Matsui Hiroki, Fushimi Kiyohide, Ando Mizuo, Yamasoba Tatsuya
Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan.
Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Head Neck. 2018 Jul;40(7):1548-1554. doi: 10.1002/hed.25139. Epub 2018 Mar 14.
Data have been limited on donor-site mechanical bowel obstruction after pharyngolaryngectomy with free jejunum graft reconstruction.
Using a nationwide Japanese inpatient database, we extracted data on patients who underwent pharyngolaryngectomy for hypopharyngeal cancer between July 2007 and March 2014. A Cox proportional hazard model was used to determine the association between background characteristics and the occurrence of mechanical bowel obstruction.
Among the 3320 eligible patients from 332 hospitals, 108 patients (3.3%) developed mechanical bowel obstruction after a median 88 (interquartile range 26-217) postoperative days. Multivariable Cox regression analysis revealed that older age (≥60 years old) was independently associated with an increased risk of mechanical bowel obstruction, whereas sex, body mass index [BMI], smoking status, comorbidity at admission, blood transfusion, history of surgery, and hospital type were not.
In pharyngolaryngectomy, careful attention should be paid to the risk of abdominal complications and, thus, to the graft choice, especially in elderly patients.
关于游离空肠移植重建喉咽切除术后供区机械性肠梗阻的数据有限。
利用日本全国住院患者数据库，我们提取了2007年7月至2014年3月期间因下咽癌接受喉咽切除术患者的数据。采用Cox比例风险模型确定背景特征与机械性肠梗阻发生之间的关联。
在来自332家医院的3320例符合条件的患者中，108例患者（3.3%）在术后中位88天（四分位间距26 - 217天）出现机械性肠梗阻。多变量Cox回归分析显示，年龄较大（≥60岁）与机械性肠梗阻风险增加独立相关，而性别、体重指数[BMI]、吸烟状况、入院时合并症、输血、手术史和医院类型则无关。
在喉咽切除术中，应特别关注腹部并发症的风险，从而关注移植物的选择，尤其是在老年患者中。
