Kim Yun-Ho, Yang Jae-Young, Ma Yoon-Hee, Lee Jin-Choon, Hwang Dae-Seok, Ryu Mi-Heon, Kim Uk-Kyu
Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Republic of Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Pusan National University, Yangsan, Republic of Korea.
Maxillofac Plast Reconstr Surg. 2024 Jul 22;46(1):28. doi: 10.1186/s40902-024-00439-4.
Many studies have been reported on tracheostomy to prevent upper airway obstruction after surgery. Among these, the scoring system proposed by Cameron et al. quantifies various factors that influence postoperative respiratory failure. This system provides a basis for surgeons to decide whether to perform an elective tracheostomy. In this study, the authors applied the Cameron scoring system retrospectively to patients undergoing severe oral cancer surgery to reevaluate the indications for elective tracheostomy and to investigate its clinical efficacy in airway management. In this study, a sample of 20 patients who underwent oral cancer surgery was selected and divided into two groups: 10 underwent tracheostomy and 10 did not. The Cameron scoring scores for each patient were extracted, to verify whether elective tracheostomy was performed in accordance with the threshold scores. Differences in scores and significant clinical impact factors between the two groups were analyzed and compared.
The 10 patients who underwent tracheostomy had an average Cameron score of 6.4, all scoring above the recommended threshold of 5 for tracheostomy. For the 10 patients who did not undergo tracheostomy, the average score was 2.5, with 8 out of these 10 patients scoring below 5. Significant clinical impact factors observed included the location and size of the tumor, the performance of mandibulectomy and neck dissection, and the type of reconstruction surgery.
In planning surgery for oral cancer patients, it is essential to consider the use of elective tracheostomy based on preoperative assessment of the risk of postoperative airway obstruction using tools like the Cameron scoring system, and patients' condition. Research confirms that elective tracheostomy effectively enhances airway management in patients with severe oral cancer.
已有许多关于气管切开术预防术后上呼吸道梗阻的研究报道。其中，卡梅隆等人提出的评分系统对影响术后呼吸衰竭的各种因素进行了量化。该系统为外科医生决定是否进行择期气管切开术提供了依据。在本研究中，作者对接受严重口腔癌手术的患者回顾性应用卡梅隆评分系统，以重新评估择期气管切开术的指征，并研究其在气道管理中的临床疗效。在本研究中，选取了20例接受口腔癌手术的患者样本并分为两组：10例行气管切开术，10例未行气管切开术。提取每位患者的卡梅隆评分，以核实是否根据阈值评分进行了择期气管切开术。分析并比较两组之间的评分差异和显著的临床影响因素。
行气管切开术的10例患者的卡梅隆评分平均为6.4，均高于气管切开术建议的阈值5分。对于未行气管切开术的10例患者，平均评分为2.5分，其中10例中有8例评分低于5分。观察到的显著临床影响因素包括肿瘤的位置和大小、下颌骨切除术和颈部清扫术的实施情况以及重建手术的类型。
在规划口腔癌患者的手术时，必须根据使用卡梅隆评分系统等工具对术后气道梗阻风险的术前评估以及患者的病情，考虑使用择期气管切开术。研究证实，择期气管切开术有效地加强了严重口腔癌患者的气道管理。
