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犬口腔肿瘤部分上颌骨切除术的术中及术后并发症

Intraoperative and postoperative complications of partial maxillectomy for the treatment of oral tumors in dogs.

作者信息

MacLellan Roxane H, Rawlinson Jennifer E, Rao Sangeeta, Worley Deanna R

出版信息

J Am Vet Med Assoc. 2018 Jun 15;252(12):1538-1547. doi: 10.2460/javma.252.12.1538.

Abstract

OBJECTIVE To characterize and identify factors associated with intraoperative and postoperative complications of maxillectomy in dogs with oral tumors. DESIGN Retrospective cohort study. ANIMALS 193 dogs that underwent maxillectomy for oral tumor excision from 2000 through 2011. PROCEDURES Data were extracted from the medical records regarding dog signalment, tumor location and size, histologic findings, clinical stage, maxillectomy category, surgical approach, and additional treatments provided. These factors were examined for associations with recorded intraoperative and postoperative outcomes. RESULTS The most common intraoperative complication was excessive surgical bleeding (103/193 [53.4%]), for which 44 (42.7%) dogs received an intraoperative blood transfusion. These outcomes were both significantly associated with tumor size and location, maxillectomy type, and surgical approach. Dogs treated with a dorsolateral combined intraoral surgical approach were more likely to have excessive surgical bleeding (48/58 [83%]) and had a longer mean duration of surgery (106 minutes) than those treated with an intraoral approach (29/54 [54%] and 77 minutes, respectively). Complications developing within 48 hours after surgery included epistaxis (99/193 [51.3%]), excessive facial swelling (71/193 [36.8%]), facial pawing (21/193 [10.9%]), and difficulty eating (22/193 [11.4%]). Complications developing within 48 hours to 4 weeks after surgery included lip trauma (22/164 [13.4%]), oronasal fistula formation (18/164 [11.0%]), wound dehiscence (18/164 [11.0%]), and infection (13/164 [7.9%]). CONCLUSIONS AND CLINICAL RELEVANCE Complications associated with maxillectomy in dogs were generally minor. Aggressive surgical planning, preparedness for hemorrhage and transfusion, careful tissue dissection, and comprehensive pain control are recommended, particularly for dogs with large, caudally located oral tumors requiring extensive excision.

摘要

目的 描述和确定与口腔肿瘤犬上颌骨切除术术中及术后并发症相关的因素。 设计 回顾性队列研究。 动物 2000年至2011年期间接受上颌骨切除术以切除口腔肿瘤的193只犬。 程序 从病历中提取有关犬的特征、肿瘤位置和大小、组织学检查结果、临床分期、上颌骨切除术类别、手术入路以及所提供的其他治疗的数据。检查这些因素与记录的术中及术后结果之间的关联。 结果 最常见的术中并发症是手术出血过多(103/193 [53.4%]),其中44只(42.7%)犬接受了术中输血。这些结果均与肿瘤大小和位置、上颌骨切除术类型及手术入路显著相关。采用背外侧联合口腔内手术入路治疗的犬更易出现手术出血过多(48/58 [83%]),且平均手术时间(106分钟)比采用口腔内入路治疗的犬(分别为29/54 [54%]和77分钟)更长。术后48小时内出现的并发症包括鼻出血(99/193 [51.3%])、面部肿胀过度(71/193 [36.8%])、面部搔抓(21/193 [10.9%])和进食困难(22/193 [11.4%])。术后48小时至4周内出现的并发症包括唇部创伤(22/164 [13.4%])、口鼻瘘形成(18/164 [11.0%])、伤口裂开(18/164 [11.0%])和感染(13/164 [7.9%])。 结论及临床意义 犬上颌骨切除术相关并发症一般较轻。建议进行积极的手术规划、做好出血和输血准备、仔细进行组织解剖以及全面控制疼痛,特别是对于需要广泛切除且肿瘤位于尾部的大型口腔肿瘤犬。

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