横腔机器人手术 (TORS) 中的临时气管切除术:从回顾性单中心分析到决策算法建议
Luigi Marco Stringa1, Giuseppe Meccariello2, Giovanni Cammaroto2
1Otolaryngology-Head and Neck Surgery Department, AP-HP, Hôpital Tenon, Sorbonne University, Paris, 75020, France. luigi.stringa@gmail.com.
一个新的算法有助于在跨口机器人手术 (TORS) 期间决定阻塞性睡眠呼吸暂停综合征 (OSAS) 或口腔状细胞癌 (OPSCC) 患者的预防性气管切除术. 高风险因素,如严重的OSAS和并发症指导了这一决定.
科学领域:
- 耳鼻喉科 耳鼻喉科 耳鼻喉科
- 手术瘤学手术瘤学
- 麻醉学 麻醉学
背景情况:
- 透口机器人手术 (TORS) 越来越多地用于口腔状细胞癌 (OPSCC),并可能因阻塞性睡眠呼吸暂停综合征 (OSAS) 而复杂化.
- 在这些患者中,关于预防性气管切除术的决定需要仔细评估风险.
研究的目的:
- 开发和提出一个决策算法,用于在接受OSAS或OPSCC的TORS患者中进行预防性气管切除术.
- 整合手术前临床数据和已建立的风险评分系统,以优化患者管理.
主要方法:
- 术前评估包括患者病史,美国麻醉学会 (ASA) 的分类,El-Ganzouri风险指数 (EGRI) 和STOP-Bang问卷.
- 对促出血因素和个体风险概况的评估指导了手术前或术后气管切除的决定.
主要成果:
- 升高的ASA和EGRI得分,凝血病,心血管疾病,高血压和吸烟与更高的气管切除率有显著联系.
- 这些因素也与术后出血风险增加有关.
结论:
- 在TORS期间应根据手术策略和患者的整体状况考虑预防性气管切除术.
- 考虑气管切除术的关键指标包括严重的OSAS,BMI>27.5,高EGRI/ASA分数,抗凝剂使用,凝血病,心血管并发症和活性物质使用.
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