Department of Otolaryngology-Head and Neck Surgery, West Virginia University Health Sciences Center, Morgantown, West Virginia.
Department of Otolaryngology-Head and Neck Surgery, Université Catholique de Louvain Centre Hospitalier Universitaire de Mont-Godinne, Yvoir, Belgium.
Laryngoscope. 2021 Jan;131(1):95-105. doi: 10.1002/lary.28580. Epub 2020 Feb 28.
Postoperative hemorrhage is the most common complication of transoral robotic surgery (TORS), the severity of which can range from minor bleeding treated with observation to catastrophic hemorrhage leading to death. To date, little is known about the incidence, risk factors, and management of post-TORS hemorrhage.
Systematic Review and Metanlysis.
A systematic review of the published literature using the Cochrane Handbook for Systematic Reviews of Interventions was performed and examined TORS, postoperative hemorrhage, and the use of prophylactic transcervical arterial ligation (TAL).
A total of 13 articles were included in the analysis. To date, there have been 332 cases of hemorrhage following a total of 5748 TORS. The pooled median post-TORS hemorrhage rate was 6.47%. The overall incidence of minor and major hemorrhage was 5.29% and 2.90%. Patients with prior radiation (relative risk [RR] = 1.46, 95% confidence interval [CI] = 1.00-2.12), large tumors (RR = 2.11, 95% CI = 1.48-2.99), and those requiring perioperative coagulation (RR = 2.25, 95% CI = 1.54-3.28) had significantly higher relative risks of hemorrhage. There was no significant difference in the relative risk of overall hemorrhage with TAL. Looking at major hemorrhage, patients undergoing TAL had a large but insignificant relative risk reduction in post-TORS hemorrhage (RR = 0.40, 95% CI = 0.15-1.07).
The incidence of post-TORS hemorrhage is low (5.78%), and for major hemorrhage requiring emergent embolization, TAL, or tracheotomy to control hemorrhage it is even lower (2.90%). Large tumors, perioperative anticoagulation, and prior radiation were associated with significantly increased risk of post-TORS hemorrhage. TAL does not reduce the overall incidence of post-TORS hemorrhage but may lead to fewer severe hemorrhages.
III Laryngoscope, 131:95-105, 2021.
术后出血是经口机器人手术（TORS）最常见的并发症，其严重程度可从仅需观察治疗的轻微出血到导致死亡的灾难性出血不等。迄今为止，对于 TORS 后出血的发生率、危险因素和处理方法知之甚少。
系统综述和荟萃分析。
使用 Cochrane 系统评价干预措施手册对已发表文献进行系统回顾，并检查 TORS、术后出血和预防性经颈动脉结扎（TAL）的使用情况。
共有 13 篇文章纳入分析。迄今为止，共有 332 例患者在总共 5748 例 TORS 后出现出血。TORS 后总体中位出血率为 6.47%。轻度和重度出血的总发生率分别为 5.29%和 2.90%。有放疗史（相对风险 [RR] = 1.46，95%置信区间 [CI] = 1.00-2.12）、肿瘤较大（RR = 2.11，95% CI = 1.48-2.99）和需要围手术期抗凝治疗（RR = 2.25，95% CI = 1.54-3.28）的患者发生出血的相对风险明显更高。TAL 与总体出血的相对风险无显著差异。对于大出血，接受 TAL 的患者在 TORS 后出血方面的相对风险降低幅度较大，但无统计学意义（RR = 0.40，95% CI = 0.15-1.07）。
TORS 后出血的发生率较低（5.78%），需要紧急栓塞、TAL 或气管切开术来控制出血的大出血发生率甚至更低（2.90%）。大肿瘤、围手术期抗凝和放疗史与 TORS 后出血的风险显著增加相关。TAL 并未降低 TORS 后出血的总体发生率，但可能导致较少的严重出血。
III 级喉镜，131：95-105，2021 年。
