与骶骨肿瘤伤口相关并发症的危险因素分析

Analysis and countermeasures to risk factors of related complications to the wound of sacral tumor

目的总结骶骨肿瘤术后伤口相关并发症类型及危险因素,探讨并发症的预防及处理。方法对1997年8月至2008年6月行手术治疗的302例骶骨肿瘤患者进行回顾性研究,总结骶骨肿瘤术后常见并发症类型、相关危险因素及处理措施。结果骶骨肿瘤患者术后最常见的并发症为切口不愈合、切口感染、脑脊液漏、内脏损伤及术后大出血。切口局部发生延迟愈合者46例(15.2%),切口感染者31例(10.3%),内脏损伤者12例(4.0%)。术后伤口不愈合、伤口感染及内脏损伤的主要危险因素为肿瘤直径>10cm、二次手术及放射治疗。术后11例患者出现大出血,其中7例患者经介入治疗病情稳定,2例患者伤口加压包扎,加快输血,病情稳定,2例患者术后出现多脏器功能衰竭死亡。1例患者术后出现多发内脏转移及骨转移死亡。术后大出血的主要危险因素为肿瘤直径>10cm、行肿瘤切刮术和肿瘤累及S2及以上。术后脑脊液漏者18例(6.0%),放射治疗及二次手术是出现脑脊液漏的主要原因。结论充分了解骶骨肿瘤患者的手术风险因素有助于判断术后情况,术前积极防范及术后有效预防及处理可以降低手术风险。

Objective To summarize the complication types and related risk factors of the wound left by the sacral tumor surgery,to discuss the prevention and treatment to complications of sacral tumor.Methods 302 patients with sacral tumor who received the resection treatment from August 1997 to June 2008 were retrospectively studied,and sacrum tumor complication types,related risk factors and treatment measures were summarized.Results The most common postoperative complications for patients with sacral tumor included the disunion of incision,the infection of incision,cerebrospinal fluid leakage,viscera injury and postoperative massive hemorrhage.The number of patients whose incision was disunited locally was 46（15.2%）;the number of patients whose incision was infected was 31（10.3%）;the number of patients whose viscera was injured was 12（4.0%）.The major risk factors for the disunion of incision,the infection of incision and viscera injury after the operation included a tumor whose diameter was more than 10 cm,a secondary surgery and radiotherapy.The number of patients who had a postoperative massive hemorrhage was 11,among which 7 patients were kept in a stable condition with interventional therapy;2 patients were kept in a stable condition by having compression bandage on the wound and accelerating the blood transfusion;2 patients suffered the function failure of multiple organs and died;1 patients suffered multiple visceral metastasis and bone metastasis and then died;the major risk factors for postoperative massive hemorrhage included a tumor whose diameter was more than 10 cm,a tumor erasion and a accumulated tumor whose level was above the S 2;the number of patients who had cerebrospinal fluid leakage was 18（6.0%）,and the major causes were radiation therapy and the secondary surgery.Conclusions To fully understand the risk factors for patients with sacral tumor surgery will help to determine the situation after the surgery;preoperative positive prevention and postoperative effective prevention and treatment will reduce the surgery risks.