骶骨肿瘤选择性靶血管栓塞后切口并发症的相关性因素分析

An analysis of factors related to incision complications following sacral tumor resection with preoperative target arterial embolism

目的评估选择性靶血管栓塞后,骶骨肿瘤切除后发生切口并发症的相关因素。方法回顾性分析自2006年1月至2013年12月,我院收治的81例术前行选择性靶血管栓塞且行后/前后联合入路肿瘤切除内固定重建的骶骨肿瘤患者的临床资料。记录患者性别、年龄、肿瘤部位、肿瘤性质、术前放疗、术前化疗、是否有糖尿病、既往手术情况、手术方式、术中出血量、手术时间等可能与切口愈合相关的因素。观察并记录患者术后皮肤愈合情况,并对上述记录的患者资料间相关性进行单因素及多因素分析,找出其中影响切口愈合不良的相关因素。结果 81例均顺利完成手术,术后18.5%(15/81)的患者出现了各类切口并发症,其中7例出现切口愈合不佳,3例出现切口窦道瘘口,2例出现切口裂开,2例出现皮肤坏死,1例出现皮肤大面积坏死。单因素分析发现术前放疗、糖尿病及手术时间与患者切口愈合不佳相关,多因素logistic回归分析提示术前放疗及糖尿病为患者术后出现切口并发症的高危因素(OR分别为20.333和38.282)。结论骶骨肿瘤选择性靶血管栓塞后切口并发症与术前放疗、糖尿病等因素相关。

Objective To investigate the factors related to incision complications following sacral tumor resection with preoperative target arterial embolism. Methods Eighty-one patients, diagnosed as sacral tumor and received preoperative target arterial embolism and posterior / posterior combined anterior approach tumor resection, were retrospectively analyzed from January 2006 to December 2013. Factors related to incision complications, including gender, age, tumor site, tumor property, preoperative radiotherapy, preoperative chemotherapy, diabetes mellitus, previous surgical history, surgical approach, blood loss and operation time were recorded. Univariate and multivariate analyses of factors were used to find the factors associating with incision complications. Results All surgeries went smoothly. 18.5%（ 15 / 81） patients had incision complications after surgery： 7 patients had poor wound healing, 3 had incision fistula, 2 had incision rupturing, 2 had skin necrosis and 1 had large area skin necrosis. Univariate analysis found that preoperative radiotherapy, diabetes mellitus and operation time were related to incision complications. Multivariate analysis showed that only preoperative radiotherapy and diabetes mellitus were high risks to incision complications（ OR 20.333, 38.282, respectively）. Conclusions Surgical incision complications following sacral tumor resection with preoperative target arterial embolism are related to preoperative radiotherapy, diabetes mellitus, etc.