| Oral squamous cell carcinoma(OSCC)originates from the mucosal epithelium of the oral cavity and throat and accounts for over 90%of oral cancers.To date,surgery is still the preferred treatment option for oral cancer in many countries.Resection of oral cancer may cause large tissue defects,requiring free tissue flap transplantation.Due to their special anatomical site specificity,oral cancer patients often complain of poor appetite,pain,and dysphagia,and a number of patients have anemia with different degrees of severity.PBT may cause adverse reactions,such as infectious diseases,hemolytic reactions,and allergic reactions alter the recipient’s immune function,leading to transfusion-related immunosuppression,which has an impact on the short-and long-term prognosis of oral cancer patients.Perioperative hypothermia increased the potential for cardiac complications and postoperative surgical site infection rates,reduced thrombin activity,which may lead to increase blood loss and red blood transfusion.Perioperative hypothermia may affect postoperative infection rates and flap survival in patients receiving free flap reconstruction for oral cancer.However,there only few studies about blood transfusion and warming method on oral cancer patients,and the research results are also controversial.This study intends to investigate the effects of blood transfusion on postoperative complications and long-term prognosis of patients with oral squamous cell carcinoma for free tissue flap reconstruction,the effects of different warming protection methods on the short-term prognosis of patients with oral cancer for free tissue flap reconstruction,and risk factors for intraoperative hypothermia in oral squamous cell carcinoma.Part Ⅰ Effects of blood transfusion on shortand long-term outcomes in oral squamous cell carcinoma patients undergoing free tissue flap reconstruction1 ObjectiveTo analyze the effect of PBT on short-and long-term outcomes in oral squamous cell carcinoma patients undergoing free tissue flap reconstruction.2 MethodsThe patients with oral squamous cell carcinoma in Zhengzhou University Affiliated Cancer Hospital who underwent free tissue flap transplantation and reconstruction were retrospectively collected.These patients were divided into two groups according to the implementation of perioperative blood transfusion.Flap revision,surgical site infection(SSI),flap failure,overall survival(OS)and disease-specific survival(DSS)were recorded and compared between the two groups.3 Results3.1 According to whether the patients received blood transfusion during the perioperative period,423 patients were included and divided into blood transfusion group(n=170)and no blood transfusion group(n=253).Compared with patients without perioperative blood transfusion,patients with perioperative blood transfusion had a higher Eastern cooperative oncology group(ECOG)status(P=0.040),more systemic diseases(P=0.004),and higher ASA grade(P=0.003).There were no significant difference in other clinical and pathological data between the two groups(P>0.05)3.2 In the PBT group(n=170),10(5.9%)flaps required exploration revision,18(10.6%)patients occurred SSI and flap necrosis was noted in 6(3.5%)patients.There was no significant difference in flap revision,surgical site infection and flap necrosis between the two groups(P>0.05).3.3 The two groups had similar DSS rates,but the 5-year OS rates were 49%and 59%in PBT group and without PBT group,respectively.This difference was significant.Patients with 4 units of PBT had OS rates comparable to those of patients with>4 units of PBT.Cox regression model confirmed that perioperative blood transfusion PBT was a risk factor for decreased overall survival(OS).(univariate Log-rank test P=0.041,multi variate COX regression P=0.012,HR=2.005,95%CI[1.087-4.003].4 ConclusionIn patients with free flap reconstruction for OSCC,PBT did not increase the short-term complication rate or decrease disease-specific survival.However,it was related to an elevated overall risk of death.Part Ⅱ Effects of different warming methods on the short-term prognosis of patients with oral cancer undergoing free tissue flap reconstruction1 ObjectiveThe purpose of this study was to assess the effects of different warming methods and times on the short-term prognosis of oral cancer patients undergoing free tissue flap reconstruction.2 MethodsThere were 142 oral cancer patients undergoing free tissue flap reconstruction were enrolled.According to different warming methods,they were divided into three groups.Group A was treated with warmed intravenous fluids,group B was treated with warmed intravenous fluids combined with intraoperative warming blanket,and group C was treated with warmed intravenous fluids combined with preoperative and intraoperative warming blanket.The differences of body temperature,intraoperative blood loss,postoperative shivering,nausea and vomiting,surgical site infection,postoperative blood coagulation,satisfaction and other short-term prognosis were compared among the three groups.3 Results3.1 Compared with groups B and C,the body temperature of group A decreased from 30 minutes after induction of anesthesia to the end of the operation;compared with group C,the body temperature of group B decreased at 30 minutes and 1 hour after induction of anesthesia(P<0.05).3.2 Compared with group B and group C,the extubation time of group A was significantly prolonged(P<0.05).3.3 There was no difference in surgical site infection rate and flap survival rate among the three groups.Compared with before operation,leucocyte count and ratio of C-reactive protein increased in the three groups after operation(P<0.05).Compared with group B and group C,leucocyte count and C-reactive protein in group A increased after operation;the rate of postoperative pulmonary infection and the number of shivering Wrench grade ≥ 2 increased in group A(P<0.05).Compared with group C,C-reactive protein in group B increased after operation(P<0.05).3.4 It was found that the postoperative APTT time in group A was longer than that before surgery.Compared with the postoperative APTT in groups B and C,the postoperative APTT time in group A was prolonged(P<0.05).3.5 The postoperative satisfaction scores of patients in group A,group B and group C increased sequentially(P<0.05).4 ConclusionFor oral cancer patients undergoing free tissue flap reconstruction warmed intravenous fluids combined with intraoperative warming blanket can shorten the time of extubation after operation,did not affect the postoperative blood coagulation function,reduced the incidence of postoperative shivering and improved the postoperative satisfaction of patients.There was no difference on the survival rate of flap.Warmed intravenous fluids combined with preoperative and intraoperative warming blanket was better.Part Ⅲ:Analysis of risk factors for intraoperative hypothermia in oral cancer patients1 ObjectiveTo explore the risk factors of intraoperative hypothermia in oral cancer patients and to establish a hypothermia prediction model.2 MethodsOral cancer patients in Zhengzhou University Affiliated Cancer Hospital were retrospectively enrolled.According to the occurrence of intraoperative hypothermia,the patients were divided into two groups,hypothermia group and non-hypothermia group.The demographic data of the patients,blood loss,fluid infusion,anesthesia duration time and operation duration time were analyzed.Binary logistic regression analysis was used to select the risk factors of intraoperative hypothermia.3 ResultsA total of 439 patients were included in this study.Univariate analysis found that age,whether to use a warming blanket,blood loss,crystalloid volume,operation duration time,and anesthesia duration time were related to the occurrence of intraoperative hypothermia(P<0.05).Multivariate Logistic regression showed that age,whether to use a warming blanket,blood loss,and anesthesia duration time were the independent risk factors for intraoperative hypothermia(P<0.05),the use of a warming blanket was a protective factor in maintaining the patient’s body temperature.The multivariate Logistic regression model of hypothermia=0.637*age-0.939*warming blanket+0.568*blood volume+0.860*anesthesia duration time-1.127.4 ConclusionAge,whether to use a warming blanket,blood loss,and anesthesia duration time were independent risk factors for intraoperative hypothermia in oral cancer patients,the use of a warming blanket was a protective factor in maintaining the patient’s body temperature. |
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