From the Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia.
Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Ann Plast Surg. 2021 Jul 1;87(1):54-58. doi: 10.1097/SAP.0000000000002578.
Parotid gland pathologies requiring resection present with varying effects on surrounding tissue architecture, and we hypothesize that this spectrum of indications confers different risks of adverse events. The purpose of this study is to elucidate the complication profiles of parotidectomy in children across a spectrum of pathologies requiring parotid resection.
The American College of Surgeons National Surgical Quality Improvement Program Pediatric data set was queried for parotidectomies performed from 2012 through 2017. Indications were subclassified based on International Classification of Diseases, Ninth Revision and Tenth Revision codes. Complications, readmissions, and reoperations were analyzed with appropriate statistics.
Parotidectomies in children (n = 208) were mostly performed for neoplasms (47.6%), followed by inflammatory conditions (24.0%). Total parotidectomies took significantly longer (P < 0.001) and remained in the hospital significantly longer than superficial parotidectomies (P < 0.001). There was no significant difference (P = 0.417) between benign neoplasms (29.3%) and malignant neoplasms (37.9%) requiring total parotidectomy. However, there was a significant difference (P = 0.014) across various malformations, with 83.3% of lymphatic malformations requiring total parotidectomy. Although lymphatic malformations required more aggressive resection, these procedures had the lowest rate of adverse events (0%). Despite the unappreciable predilection toward total parotidectomy based on nature of neoplasms, parotidectomy performed for malignant neoplasms had a significantly increased risk of nerve injury (P < 0.001; odds ratio [OR], 3563) and medical complications (P < 0.001; OR, 67.2), whereas those performed for benign neoplasms did not have an increased risk of these complications (all P's > 0.209). Parotidectomy performed for vascular malformations had significantly increased risk of bleeding requiring transfusion (P < 0.001; OR, 14.9) and surgical complications (P < 0.001; OR, 9.2). Bleeding requiring transfusion was significantly related to longer surgical procedures (P < 0.001; 409 vs 191 minutes).
Parotidectomy in pediatric patients for malignant neoplasms is associated with a significantly higher risk of nerve injury compared with parotidectomy for benign neoplasms. Parotidectomy for vascular malformations has a significantly higher risk of bleeding requiring transfusion, whereas parotidectomy for lymphatic malformations is associated with the lowest risk of medical and surgical complications.
需要切除腮腺的腺体疾病会对周围组织结构产生不同的影响，我们假设这种适应证范围会带来不同的不良事件风险。本研究旨在阐明各种需要切除腮腺的腺体疾病患者行腮腺切除术的并发症谱。
查询美国外科医师学院国家外科质量改进计划儿科数据库，获取 2012 年至 2017 年期间行腮腺切除术的病例。根据国际疾病分类第 9 版和第 10 版的代码对适应证进行亚分类。使用适当的统计学方法分析并发症、再入院和再次手术的情况。
儿童腮腺切除术（n=208）主要用于肿瘤（47.6%），其次是炎症性疾病（24.0%）。全腮腺切除术的手术时间明显更长（P<0.001），住院时间也明显更长（P<0.001）。良性肿瘤（29.3%）和恶性肿瘤（37.9%）行全腮腺切除术的比例无显著差异（P=0.417）。然而，各种畸形之间存在显著差异（P=0.014），淋巴管瘤有 83.3%需要行全腮腺切除术。尽管淋巴管瘤需要更积极的切除，但这些手术的不良事件发生率最低（0%）。尽管根据肿瘤性质，行全腮腺切除术的倾向并不明显，但由于恶性肿瘤行腮腺切除术的神经损伤风险显著增加（P<0.001；比值比[OR]为 3563）和医疗并发症风险显著增加（P<0.001；OR 为 67.2），而良性肿瘤行腮腺切除术无上述并发症风险增加（所有 P 值均>0.209）。由于血管畸形行腮腺切除术的出血需要输血的风险显著增加（P<0.001；OR 为 14.9）和手术并发症风险显著增加（P<0.001；OR 为 9.2）。需要输血的出血与手术时间较长显著相关（P<0.001；409 分钟比 191 分钟）。
与良性肿瘤相比，儿童恶性肿瘤患者行腮腺切除术与神经损伤风险显著增加相关。由于血管畸形行腮腺切除术的出血需要输血的风险显著增加，而由于淋巴管瘤行腮腺切除术与医疗和手术并发症的风险最低相关。
