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论著 | 更新时间:2026-09-08
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口腔颌面部恶性肿瘤术后发生中重度并发症的危险因素分析▲
Analysis of risk factors for postoperative moderate-to-severe complications in patients with oral and maxillofacial malignant tumors

微创医学 页码:454-460

作者机构:1 广西医科大学附属口腔医院手术麻醉科,广西南宁市 530000;2 广西医科大学公共卫生学院,广西南宁市 530000

基金信息:广西壮族自治区卫生健康委员会自筹经费科研课题(编号:Z-A20250634) *通信作者 陈秋妙为共同通信作者

DOI:10.11864/j.issn.1673.2026.04.07

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目的 探讨口腔颌面部恶性肿瘤术后发生中重度并发症(Clavien-Dindo分级≥Ⅱ级)的危险因素。方法 回顾性分析662例行手术治疗的口腔颌面部恶性肿瘤患者的临床资料。根据术后并发症分级(Clavien-Dindo分级)将患者分为无/Ⅰ级并发症组和≥Ⅱ级并发症组,比较两组临床资料,采用二元Logistic回归分析口腔颌面部恶性肿瘤患者术后发生Clavien-Dindo分级≥Ⅱ级并发症的影响因素,并基于危险因素构建列线图预测模型,绘制受试者操作特征(ROC)曲线和校准曲线评估模型的区分度与校准度。结果 662例行手术治疗的口腔颌面部恶性肿瘤患者中,共有355例(53.6%)术后发生并发症,Clavien-Dindo分级≥Ⅱ级并发症共268例(40.5%)。无/Ⅰ级并发症组和≥Ⅱ级并发症组体重指数、高脂血症、术前贫血、术前低钠血症、术中低血压、手术时长及TNM分期差异有统计学意义(P<0.05)。Logistic回归分析结果显示,体重指数<18.5 kg/m2、高脂血症、术前贫血、术中低血压、手术时长≥ 240 min、TNM分期Ⅲ期是口腔颌面部恶性肿瘤手术患者术后发生Clavien-Dindo分级≥Ⅱ级并发症的危险因素(P<0.05),基于危险因素构建预测口腔颌面部恶性肿瘤手术患者术后发生Clavien-Dindo分级≥Ⅱ级并发症的列线图模型具有较好的区分度、校准度和内部一致性。结论 口腔颌面部恶性肿瘤手术患者术后并发症发生率较高,体重指数<18.5 kg/m2、高脂血症、术前贫血、术中低血压、手术时长≥240 min、TNM分期Ⅲ期是该类患者术后发生Clavien-Dindo分级≥Ⅱ级并发症的危险因素,基于上述危险因素构建的列线图模型具有较好的区分度和校准度,临床应用价值较高。 

Objective To explore the risk factors for postoperative moderate-to-severe complications (Clavien-Dindo grade ≥Ⅱ) in patients with oral and maxillofacial malignant tumors. Methods Clinical data of 662 patients receiving surgical resection for oral and maxillofacial malignant tumors were retrospectively reviewed. Patients were categorized into the no/grade Ⅰ complication group and grade ≥Ⅱ complication group in accordance with the Clavien-Dindo grade of postoperative complications. Baseline characteristics were compared between groups. Binary Logistic analysis regression was performed to screen predictors of postoperative Clavien-Dindo grade ≥Ⅱ complications in patients with oral and maxillofacial malignant tumors. A nomogram prediction model was constructed incorporating independent risk factors. Receiver operating characteristic (ROC) curve and calibration curve were generated to assess the discriminative ability and calibration of the model. Results Among the 662 patients undergoing surgical treatment for malignant tumors of the oral and maxillofacial region, postoperative complications occurred in 355 cases (53.6%), and 268 cases (40.5%) presented with complications of Clavien-Dindo grade ≥Ⅱ. There were statistically significant differences between the no/grade Ⅰ complication group and grade ≥Ⅱ complication group in body mass index, hyperlipidemia, preoperative anemia, preoperative hyponatremia, intraoperative hypotension, operative duration and TNM stage (P<0.05). Logistic regression analysis revealed that body mass index <18.5 kg/m², hyperlipidemia, preoperative anemia, intraoperative hypotension, operative duration ≥240 min, and TNM stage Ⅲ were risk factors for postoperative Clavien-Dindo grade ≥Ⅱ complications in patients undergoing surgery for oral and maxillofacial malignant tumors (P<0.05). The nomogram model constructed based on these risk factors exhibited good discrimination, calibration and internal consistency for predicting postoperative Clavien-Dindo grade ≥Ⅱ complications in patients undergoing surgery for oral and maxillofacial malignant tumors. Conclusion Patients undergoing surgery for oral and maxillofacial malignant tumors have a relatively high incidence of postoperative complications. Body mass index <18.5 kg/m2, hyperlipidemia, preoperative anemia, intraoperative hypotension, operative duration ≥240 min, and TNM stage Ⅲ are risk factors for developing postoperative Clavien-Dindo grade ≥Ⅱ complications. The nomogram model constructed based on the above risk factors has good discrimination and calibration, with high clinical application value.

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