Mohamedbhai H, Ali S, Dimasi I, Kalavrezos N
Head and Neck Centre, University College London Hospital, 250 Euston Road, London NW1 2BU.
Southmead Hospital, Southmead Road, Westbury-on-Trym, Bristol, BS10 5NB.
Br J Oral Maxillofac Surg. 2018 Oct;56(8):709-714. doi: 10.1016/j.bjoms.2018.07.015. Epub 2018 Aug 17.
Our aim was to provide a simple and effective scoring system to guide decision making in management of the airway. We retrospectively reviewed the casenotes of all patients diagnosed with head and neck cancer and who were treated by resection with primary flap reconstruction. Those factors that were significant (p<0.05) were analysed by logistic regression to establish their weighting. A total of 149 patients were included, 67 of whom (45%) were managed with endotracheal tubes, and 82 with tracheostomy (55%), of which eight were unplanned and late. From this we produced a score based on: T (T staging), R (Reconstruction), A (Anatomy of tumour), C (Coexisting conditions), H (History of previous treatment for head and neck cancer), Y (lateralitY- bilateral neck dissection). A score of 4 gave a sensitivity of 91.4%, a positive predictive value of 90.9%, a specificity of 90.8% and a negative predictive value of 88.2%. We applied this score to the patients, and it gave a mean score of: 2.1 (intubated), 5.7 (primary tracheostomy), and 4.6 (late tracheostomy). This is the largest published study to our knowledge of tracheostomies in head and neck cancer flap reconstructions that presents a scoring system for management of the airway. This scoring system can appropriately predict those patients who do not need tracheostomy and can act as a reliable screening tool in preoperative planning of the airway. It could aid management, and reduce the incidence of postoperative tracheostomies, with the potential that patients could be managed more safely, with reduced morbidity and mortality.
我们的目标是提供一种简单有效的评分系统，以指导气道管理中的决策制定。我们回顾性分析了所有诊断为头颈癌并接受原发性皮瓣重建切除术治疗的患者的病历。对具有显著意义（p<0.05）的因素进行逻辑回归分析以确定其权重。总共纳入了149例患者，其中67例（45%）通过气管插管进行管理，82例（55%）进行了气管切开术，其中8例为非计划性和晚期气管切开术。据此，我们制定了一个基于以下因素的评分：T（T分期）、R（重建）、A（肿瘤解剖结构）、C（并存疾病）、H（头颈癌既往治疗史）、Y（侧别-双侧颈清扫）。评分4时，敏感性为91.4%，阳性预测值为90.9%，特异性为90.8%，阴性预测值为88.2%。我们将此评分应用于患者，结果显示平均评分为：2.1（插管患者）、5.7（一期气管切开术患者）和4.6（晚期气管切开术患者）。据我们所知，这是关于头颈癌皮瓣重建术中气管切开术的已发表研究中规模最大的一项，该研究提出了一种气道管理评分系统。这种评分系统能够适当地预测那些不需要气管切开术的患者，并可作为气道术前规划中的可靠筛查工具。它有助于管理，降低术后气管切开术的发生率，有可能使患者得到更安全的管理，降低发病率和死亡率。
