目的:探讨数字化外科技术在肿瘤切除后头颈部缺损重建中的应用价值,并对时间-经济效益-成本进行综合评价。
方法:回顾性分析2015年1月至2021年1月在四川省肿瘤医院接受头颈部手术重建手术的头颈部肿瘤患者的临床资料。根据纳入和排除标准,共纳入52例,其中采用数字手术(DS)25例,采用常规手术(CS)27例。临床病理特征,术后并发症,功能美学评价指标,比较两组患者的时间-费用-满意度评价指标,并进行统计学分析。共享使用数字手术的典型病例。
结果:两组之间的结果具有可比性,两组生存结局及随访时间比较差异无统计学意义(P>0.05)。两组缺损大小无显著差异,病理类型,其他主要临床病理特征,或手术相关指标(P>0.05)。钛板位移的发生率,变形或暴露,DS组面部瘢痕畸形明显低于CS组(P<0.05)。然而,其他短期或长期并发症比较差异无统计学意义(P>0.05)。DS组吞咽困难和进食障碍发生率明显降低(P<0.05)。演讲和社会功能得到改善,但不显著(P>0.05)。同时,面部美学评价指标差异无统计学意义(P>0.05)。此外,总操作时间,从供体部位制备骨瓣的时间,截骨时间,重建时间显著低于传统手术组(P<0.05),但不能缩短受区的成形时间和血管吻合时间(P>0.05)。此外,DS组与CS组住院天数比较差异无统计学意义(P>0.05),DS组ICU治疗时间及术后静脉营养支持时间均短于CS组(P<0.05)。特别是,DS组的术前医患沟通更有效,术后患者包括家属的治疗满意度较高(P<0.05)。
结论:数字外科技术的综合应用(CAD,CAM,VR,MA,等。)在头颈部肿瘤切除后的重建在临床上是可行的,这不仅可以提高修复的准确性,减少一些手术并发症,更好地保存和改善患者的饮食和言语功能,减少手术和住院时间,还增加了治疗费用。此外,有利于医患沟通,提高患者满意度。
OBJECTIVE: Discuss the application value of digital surgical technology in the reconstruction of head and neck defects after tumor resection and comprehensively evaluate time-economic-benefit cost.
METHODS: A retrospective analysis of head and neck cancer patients who underwent reconstructive operations in head and neck surgery at Sichuan Cancer Hospital from January 2015 to January 2021 was performed. According to the inclusion and exclusion criteria, a total of 52 cases were included, including 25 cases using digital surgery (DS) and 27 cases using the conventional surgery (CS). The clinical-pathological characteristics, postoperative complications, functional aesthetic evaluation indexes, and time-cost-satisfaction evaluation indexes between the two groups were compared and statistically analyzed. Typical cases using digital surgery were shared.
RESULTS: Outcomes between the two groups were comparable, and there was no significant difference in survival outcome and follow-up time between the two groups (P > 0.05). There was no significant difference between the two groups in the defect size, pathological type, other major clinicopathological features, or operation-related indicators (P > 0.05). The incidence of titanium plate displacement, deformation or exposure, and facial scar deformity in the DS group was significantly lower than that in the CS group (P < 0.05). However, there was no significant difference in other short-term or long-term complications (P > 0.05). The incidence of dysphagia and eating disorders in the DS group was significantly reduced (P < 0.05). The speech and social functions were improved, but not significantly (P > 0.05). Meanwhile, there was no significant difference in the evaluation index of facial aesthetics in this
study (P > 0.05). Furthermore, the total operation time, preparation time of bone flap from the donor site, osteotomy time, and reconstruction time in the DS group were significantly lower than those in the traditional operation group (P < 0.05), but the shaping time and vascular anastomosis time of recipient area could not be shortened (P > 0.05). In addition, there was no significant difference in total hospitalization days between the DS group and CS group (P > 0.05), but the time of ICU treatment and postoperative intravenous nutrition support in the DS group were shorter than those in the CS group (P < 0.05). In particular, the preoperative doctor-patient communication of the DS group was more effective, and the treatment satisfaction of patients including their families was higher after operation (P < 0.05).
CONCLUSIONS: Comprehensive application of digital surgical technology (CAD, CAM, VR, MA, etc.) in the reconstruction of the head and neck after tumor resection is feasible in clinical practice, which can not only improve the accuracy of repair, decrease some surgical complications, better preserve and improve patient\'s diet and speech function, and reduce the operation and hospitalization time, but also increase the treatment cost. Furthermore, it is conducive to doctor-patient communication and improves patient satisfaction.