不同年龄组腮腺肿瘤术后患者发生面瘫风险及影响因素分析：一项回顾性研究

Analysis of Facial Palsy Risk and Influencing Factors in Postoperative Patients with Parotid Gland Tumors across Different Age Groups: A Retrospective Study

摘要: 目的：探讨不同年龄段腮腺肿瘤术后面瘫的发生风险及其影响因素，为临床制定个体化干预策略提供依据。方法：回顾性纳入2013年至2023年在贵港市人民医院接受腮腺肿瘤手术的398例患者，根据世界卫生组织年龄标准分为青年组(18~44岁)、中年组(45~59岁)和老年组(≥60岁)。收集27项人口学、临床和实验室相关变量，采用单因素分析筛选候选变量，并进一步纳入多因素logistic回归模型，分析各年龄组面瘫发生的独立影响因素。结果：腮腺肿瘤术后面瘫的总体发生率为13.57%，其中老年组(17.39%)显著高于中年组(12.25%)与青年组(10.47%)。多因素回归显示，在全人群中，肿瘤性质(OR = 8.01)、肿瘤疼痛(OR = 3.48)、手术医师经验(OR = 1.05)、BMI (OR = 1.12)、肿瘤体积(OR = 1.01)、PTT延长(OR = 1.11)为面瘫风险因素，而PDW升高(OR = 0.74)为保护因素。分年龄分析显示，青年组中肿瘤疼痛(OR = 26.07)，中年组中肿瘤恶性(OR = 3.01)、BMI升高和肿瘤体积增大，老年组中肿瘤恶性(OR = 11.84)、肿瘤体积和球蛋白下降(OR = 0.90)与面瘫发生密切相关。结论：年龄是腮腺肿瘤术后面瘫的重要影响因素，各年龄段存在不同的危险特征。肿瘤性质与体积为贯穿各年龄组的共同风险因素；术前评估炎症、凝血状态、体重及肿瘤疼痛特征，对于降低术后面瘫风险具有重要临床意义。未来应加强术前个体化评估与术中神经保护策略的应用。

Abstract: Objective: To investigate the risk and associated factors of postoperative facial paralysis in patients with parotid gland tumors across different age groups, aiming to provide clinical evidence for individualized surgical strategies. Methods: A retrospective analysis was conducted on 398 patients who underwent parotid gland tumor surgery at Guigang People’s Hospital from 2013 to 2023. Patients were stratified into youth (18~44 years), middle-aged (45~59 years), and elderly (≥60 years) groups according to the WHO age classification. A total of 27 demographic, clinical, and laboratory variables were collected. Univariate analyses were performed to identify potential risk factors, which were further included in multivariate logistic regression models to determine independent predictors of postoperative facial paralysis in each age group. Results: The overall incidence of postoperative facial paralysis was 13.57%, with a significantly higher rate observed in the elderly group (17.39%) compared to the middle-aged (12.25%) and youth groups (10.47%). In the overall population, tumor malignancy (OR = 8.01), tumor pain (OR = 3.48), surgeon experience (OR = 1.05), BMI (OR = 1.12), tumor volume (OR = 1.01), and prolonged partial thromboplastin time (PTT) (OR = 1.11) were identified as risk factors, while increased platelet distribution width (PDW) (OR = 0.74) was protective. The analysis by age groups shows that in the young group, tumor pain (OR = 26.07) is closely related to the occurrence of facial palsy. In the middle-aged group, the malignancy of the tumor (OR = 3.01), increased BMI, and enlarged tumor volume are closely related to the occurrence of facial palsy. In the elderly group, the malignancy of the tumor (OR = 11.84), decreased tumor volume, and decreased globulin (OR = 0.90) are closely related to the occurrence of facial palsy. Conclusion: Age is a significant determinant of facial paralysis following parotid tumor surgery, with distinct risk profiles observed across age groups. Tumor malignancy and volume emerged as consistent risk factors regardless of age. Preoperative evaluation of inflammation, coagulation status, BMI, and tumor pain may help reduce postoperative complications. Personalized surgical planning and intraoperative nerve protection strategies are essential, particularly for elderly patients.