Department of Maxillofacial Surgery, Jiamusi Central Hospital, Heilongjiang, China.
Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, National Clinical Research Centre of Stomatology, Shanghai, China.
Int J Oral Maxillofac Surg. 2020 Nov;49(11):1416-1420. doi: 10.1016/j.ijom.2020.03.005. Epub 2020 Apr 7.
Free flap reconstruction after resection in paediatric patients with head and neck cancer (HNC) has various clinical challenges, which have not yet been fully investigated. This retrospective study was implemented to investigate these factors. Paediatric patients (≤14 years old) who underwent free flap reconstructions following surgery for HNC at a tertiary referral centre during the years 2009-2018 were included. Clinical, pathological, and imaging data were collected and analysed. Overall, 47 patients were included, 26 male and 21 female. Thirty-four patients were ASA status I and 13 were ASA status II. The median operative time was 415 minutes, while the median intraoperative blood loss was 500 ml. Seventeen patients had a tracheotomy. Fourteen medical complications (six pulmonary infection, six diarrhoea, two pulmonary aspiration) and six surgical complications (one haematoma beneath flap, two wound dehiscence, one salivary fistula, one effusion, one tracheotomy haemorrhage) were observed. Tracheotomy was associated with medical complications (P = 0.003) and total complications (P = 0.024). It was confirmed that microvascular reconstruction can be adopted in paediatric HNC patients, while tracheotomy and nasal feeding tubes should be used with caution. Comprehensive preoperative assessment, gentle handling of the tissues during operative procedures, and appropriate postoperative management will reduce the risk of complications.
儿童头颈部癌症（HNC）患者切除术后游离皮瓣重建存在多种临床挑战，这些挑战尚未得到充分研究。本回顾性研究旨在调查这些因素。纳入 2009 年至 2018 年在三级转诊中心因 HNC 接受手术并随后行游离皮瓣重建的儿科患者（≤14 岁）。收集并分析了临床、病理和影像学数据。共有 47 例患者纳入研究，其中男 26 例，女 21 例。34 例患者为 ASA Ⅰ级，13 例为 ASA Ⅱ级。中位手术时间为 415 分钟，中位术中出血量为 500ml。17 例行气管切开术。观察到 14 例内科并发症（6 例肺部感染，6 例腹泻，2 例肺吸入）和 6 例外科并发症（1 例皮瓣下血肿，2 例伤口裂开，1 例涎瘘，1 例积液，1 例气管切开术出血）。气管切开术与内科并发症（P=0.003）和总并发症（P=0.024）相关。证实游离皮瓣重建可应用于儿童 HNC 患者，但气管切开术和鼻饲管应谨慎使用。全面的术前评估、手术过程中对组织的轻柔处理以及适当的术后管理将降低并发症的风险。
