月经周期阶段与鼻整形术后早期眶周水肿和瘀斑：一项观察性研究

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中文摘要

背景： 估计的月经周期阶段是否影响鼻整形术后恢复仍不清楚。尽管既往鼻整形研究已涉及术中出血，但其与术后早期可见结局如眶周水肿和瘀斑的关系尚未得到充分描述。
方法： 这项前瞻性观察性队列研究纳入72名月经规律的女性，她们于2025年2月1日至12月1日期间接受初次开放式鼻整形术。所有手术均由同一位资深外科医生采用标准化的压电技术完成。月经阶段根据末次月经和通常周期长度，使用预先定义的日历法标准进行估计。术前血清雌二醇和孕酮作为生化特征进行测量，未用于确定阶段分组。下眼睑水肿、上眼睑水肿、下眼睑瘀斑和上眼睑瘀斑在术后第1天和第3天由一名对月经阶段和激素值不知情的独立评估者使用0-4级序数量表分别评分。组间比较采用Kruskal-Wallis检验及Dunn-Bonferroni事后分析。探索性累积logit混合效应模型考虑了重复评估，并调整了术后天数、年龄、手术时长和鼻中隔矫正。
结果： 平均年龄为25.75±5.46岁。基于日历法的分类确定估计卵泡期组28例、估计围排卵期组8例和估计黄体期组36例。雌二醇水平在围排卵期最高，而孕酮水平在黄体期最高。在两个术后日，所有水肿和瘀斑结局均观察到显著的组间差异。卵泡期始终显示最低评分。尽管围排卵期与黄体期之间未检测到统计学显著差异，但围排卵期亚组样本量小，无法将该发现解释为等效性证据。调整分析总体上支持这些关联，尽管上眼睑水肿的围排卵期-卵泡期对比不精确且无统计学显著性（aOR 4.80，95% CI 0.96-23.95）。
结论： 估计的月经周期阶段与术后早期眶周水肿和瘀斑相关，卵泡期组评分总体较低。这些探索性发现具有假设生成性质，不能确立因果关系，也不足以支持仅根据月经阶段常规调整鼻整形手术安排。

英文摘要

BACKGROUND: Whether estimated menstrual cycle phase affects postoperative recovery after rhinoplasty remains unclear. Although previous rhinoplasty research has addressed intraoperative bleeding, its relationship with visible early postoperative outcomes such as periorbital edema and ecchymosis has not been well characterized.
METHODS: This prospective observational cohort study included 72 regularly menstruating women who underwent primary open rhinoplasty between February 1 and December 1, 2025. All procedures were performed by the same senior surgeon using a standardized piezoelectric technique. Menstrual phase was estimated from the last menstrual period and usual cycle length using predefined calendar-based criteria. Preoperative serum estradiol and progesterone were measured as biochemical characteristics and were not used to determine phase assignment. Lower eyelid edema, upper eyelid edema, lower eyelid ecchymosis, and upper eyelid ecchymosis were scored separately on postoperative days 1 and 3 using a 0-4 ordinal scale by an independent evaluator blinded to menstrual phase and hormone values. Between-group comparisons were performed using the Kruskal-Wallis test with Dunn-Bonferroni post hoc analysis. Exploratory cumulative-logit mixed-effects models accounted for repeated assessments and adjusted for postoperative day, age, operative duration, and septal correction.
RESULTS: The mean age was 25.75 ± 5.46 years. Calendar-based classification identified 28 patients in the estimated follicular group, 8 in the estimated periovulatory group, and 36 in the estimated luteal group. Estradiol levels were highest in the periovulatory phase, whereas progesterone levels were highest in the luteal phase. Significant between-phase differences were observed for all edema and ecchymosis outcomes on both postoperative days. The follicular phase consistently showed the lowest scores. Although no statistically significant difference was detected between the periovulatory and luteal phases, the small periovulatory subgroup precludes interpreting this finding as evidence of equivalence. Adjusted analyses generally supported these associations, although the periovulatory-follicular contrast for upper eyelid edema was imprecise and not statistically significant (aOR 4.80, 95% CI 0.96-23.95).
CONCLUSION: Estimated menstrual cycle phase was associated with early postoperative periorbital edema and ecchymosis, with generally lower scores in the follicular group. These exploratory findings are hypothesis-generating and do not establish causality or justify routine modification of rhinoplasty scheduling based solely on menstrual phase.