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数字化手术组与传统经验组在头颈部重建中的对比:一项分析临床价值及时间 - 经济 - 社会效应的回顾性对照研究

Digital surgery group versus traditional experience group in head and neck reconstruction: a retrospective controlled study to analyze clinical value and time-economic-social effect.

作者信息

Sun Ronghao, Zhou Yuqiu, Malouta Michelle Z, Cai Yongcong, Shui Chunyan, Zhu Li, Wang Xu, Zhu Jingqiang, Li Chao

机构信息

Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.

Department of Head and Neck Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, China.

出版信息

World J Surg Oncol. 2022 Jun 30;20(1):220. doi: 10.1186/s12957-022-02677-0.

Abstract

OBJECTIVE

Discuss the application value of digital surgical technology in the reconstruction of head and neck defects after tumor resection and comprehensively evaluate time-economic-benefit cost.

METHODS

A retrospective analysis of head and neck cancer patients who underwent reconstructive operations in head and neck surgery at Sichuan Cancer Hospital from January 2015 to January 2021 was performed. According to the inclusion and exclusion criteria, a total of 52 cases were included, including 25 cases using digital surgery (DS) and 27 cases using the conventional surgery (CS). The clinical-pathological characteristics, postoperative complications, functional aesthetic evaluation indexes, and time-cost-satisfaction evaluation indexes between the two groups were compared and statistically analyzed. Typical cases using digital surgery were shared.

RESULTS

Outcomes between the two groups were comparable, and there was no significant difference in survival outcome and follow-up time between the two groups (P > 0.05). There was no significant difference between the two groups in the defect size, pathological type, other major clinicopathological features, or operation-related indicators (P > 0.05). The incidence of titanium plate displacement, deformation or exposure, and facial scar deformity in the DS group was significantly lower than that in the CS group (P < 0.05). However, there was no significant difference in other short-term or long-term complications (P > 0.05). The incidence of dysphagia and eating disorders in the DS group was significantly reduced (P < 0.05). The speech and social functions were improved, but not significantly (P > 0.05). Meanwhile, there was no significant difference in the evaluation index of facial aesthetics in this study (P > 0.05). Furthermore, the total operation time, preparation time of bone flap from the donor site, osteotomy time, and reconstruction time in the DS group were significantly lower than those in the traditional operation group (P < 0.05), but the shaping time and vascular anastomosis time of recipient area could not be shortened (P > 0.05). In addition, there was no significant difference in total hospitalization days between the DS group and CS group (P > 0.05), but the time of ICU treatment and postoperative intravenous nutrition support in the DS group were shorter than those in the CS group (P < 0.05). In particular, the preoperative doctor-patient communication of the DS group was more effective, and the treatment satisfaction of patients including their families was higher after operation (P < 0.05).

CONCLUSION

Comprehensive application of digital surgical technology (CAD, CAM, VR, MA, etc.) in the reconstruction of the head and neck after tumor resection is feasible in clinical practice, which can not only improve the accuracy of repair, decrease some surgical complications, better preserve and improve patient's diet and speech function, and reduce the operation and hospitalization time, but also increase the treatment cost. Furthermore, it is conducive to doctor-patient communication and improves patient satisfaction.

摘要

目的

探讨数字外科技术在肿瘤切除术后头颈部缺损重建中的应用价值,并综合评估时间-经济-效益成本。

方法

回顾性分析2015年1月至2021年1月在四川省肿瘤医院头颈外科接受重建手术的头颈癌患者。根据纳入和排除标准,共纳入52例,其中25例采用数字外科(DS),27例采用传统手术(CS)。比较两组患者的临床病理特征、术后并发症、功能美学评价指标以及时间-成本-满意度评价指标,并进行统计学分析。分享数字外科典型病例。

结果

两组患者的预后相当,两组患者的生存结局和随访时间差异无统计学意义(P>0.05)。两组患者在缺损大小、病理类型、其他主要临床病理特征或手术相关指标方面差异无统计学意义(P>0.05)。DS组钛板移位、变形或外露以及面部瘢痕畸形的发生率明显低于CS组(P<0.05)。然而,其他短期或长期并发症差异无统计学意义(P>0.05)。DS组吞咽困难和进食障碍的发生率明显降低(P<0.05)。言语和社交功能有所改善,但差异无统计学意义(P>0.05)。同时,本研究中面部美学评价指标差异无统计学意义(P>0.05)。此外,DS组的总手术时间、供区骨瓣制备时间、截骨时间和重建时间均明显低于传统手术组(P<0.05),但受区塑形时间和血管吻合时间无法缩短(P>0.05)。另外,DS组和CS组的总住院天数差异无统计学意义(P>0.05),但DS组的ICU治疗时间和术后静脉营养支持时间短于CS组(P<0.05)。特别是,DS组术前医患沟通更有效,患者及其家属术后的治疗满意度更高(P<0.05)。

结论

数字外科技术(CAD、CAM、VR、MA等)在肿瘤切除术后头颈部重建中的综合应用在临床实践中是可行的,不仅可以提高修复的准确性,减少一些手术并发症,更好地保留和改善患者的饮食及言语功能,缩短手术和住院时间,还会增加治疗成本。此外,有利于医患沟通,提高患者满意度。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4aaa/9245239/b511f4669526/12957_2022_2677_Fig1_HTML.jpg

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