口腔癌患者接受微血管游离皮瓣下颌骨重建后的后气道间隙与放疗的关系：一项单中心研究
Posterior airway space following mandibular reconstruction using microvascular free flaps in oral cancer patients in relation to radiotherapy: a single-center study.
文献信息
| PMID | 42712385 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Stefan Heene |
| 作者单位 | Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Faculty of Medicine, Albert Ludwig University of Freiburg, Freiburg im Breisgau, Baden-Württemberg, Germany. |
| 期刊 | Frontiers in oncology |
| SCI 分区 | Q2 |
| IF | 3.9 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
引言： 后气道间隙（PAS）具有重要的临床意义，因为该区域的气道阻塞可能损害患者的健康状况，表现为从急性呼吸困难到慢性阻塞性睡眠呼吸暂停等一系列症状。尽管既往研究已证实口腔颌面外科手术后PAS会发生显著改变，但口腔癌患者接受微血管重建后PAS的变化仍研究不足。本研究旨在评估下颌骨切除及微血管游离皮瓣重建后PAS的变化，重点关注放疗的影响。
方法： 在这项回顾性单中心研究中，评估了2020年1月1日至2025年1月1日期间接受治疗的口腔癌患者。符合纳入条件的患者需接受过下颌骨切除并随后行一期微血管重建，且具有术前和术后最大层厚为1 mm的计算机断层扫描（CT）图像。使用3D Slicer（The Slicer Community，www.slicer.org）对影像数据进行分割，并以立方厘米（cm³）为单位量化PAS体积。随后分析个体内PAS体积变化，并评估潜在影响因素，如辅助放疗、缺损类型和重建方法。
结果： 共42例患者（18例女性，24例男性；平均年龄66 ± 13岁）纳入分析。总体而言，术后首次CT扫描时PAS体积平均增加11.6%（95% CI：-6.8%至29.9%）。在一年随访时（平均381天），PAS体积较基线显著增加58.5%（95% CI：39.7%至77.2%）（p = 0.0023）。接受辅助放疗的患者PAS体积增加显著更大（p = 0.0266）。此外，多元线性回归确定颈部淋巴结清扫、缺损类型、重建方法和辅助化疗是与一年随访时PAS体积变化显著相关的独立因素。
讨论： 下颌骨切除后行微血管重建与口腔癌患者PAS体积总体显著增加相关。然而，多种因素——尤其是辅助放疗——与PAS改变的程度显著相关。
英文摘要
INTRODUCTION: The posterior airway space (PAS) is of considerable clinical relevance, as airway obstruction in this region may compromise patient well-being, manifesting as symptoms ranging from acute dyspnea to chronic obstructive sleep apnea. Although previous studies have demonstrated significant alterations in the PAS following oral and maxillofacial surgical procedures, changes in the PAS among patients with oral cancer undergoing microvascular reconstruction remain insufficiently investigated. This study aimed to evaluate changes in PAS following mandibular resection and microvascular free flap reconstruction, focusing on the impact of radiotherapy.
METHODS: In this retrospective, single-center study, patients with oral cancer treated between January 1, 2020, and January 1, 2025, were assessed. Patients were eligible for inclusion if they had undergone mandibular resection followed by primary microvascular reconstruction and if preoperative and postoperative computed tomography (CT) scans with a maximum slice thickness of 1 mm were available. Imaging data were segmented using 3D Slicer (The Slicer Community, www.slicer.org), and PAS volume was quantified in cubic centimeters (cm³). Intraindividual changes in PAS volume were subsequently analyzed, and potential influencing factors, such as adjuvant radiotherapy, defect type, and reconstruction method, were evaluated.
RESULTS: A total of 42 patients (18 females, 24 males; mean age 66 ± 13 years) were included in the analysis. Overall, PAS volume increased by a mean of 11.6% (95% CI: -6.8% to 29.9%) on the first postoperative CT scan. At one-year follow-up (mean 381 days), PAS volume had increased significantly by 58.5% (95% CI: 39.7% to 77.2%) compared with baseline (p = 0.0023). The increase in PAS volume was significantly greater in patients who received adjuvant radiotherapy (p = 0.0266). Furthermore, multiple linear regression identified neck dissection, defect type, reconstruction method, and adjuvant chemotherapy as independent factors significantly associated with changes in PAS volume at the one-year follow-up.
DISCUSSION: Mandibular resection followed by microvascular reconstruction is associated with a significant overall increase in PAS volume in patients with oral cancer. However, multiple factors - particularly adjuvant radiotherapy - are significantly associated with the extent of PAS alteration.