颈动脉体瘤切除术后不良事件危险因素分析

Risk factors for adverse events after carotid body tumor resection

目的分析颈动脉体瘤(CBT)切除术后发生不良事件(脑卒中、全因死亡、复发、远处转移、神经损伤)的危险因素。方法回顾性分析2007年6月至2020年5月复旦大学附属中山医院接受手术治疗并行病理学检查的单侧CBT患者242例,根据患者术后情况分为不良事件组和无不良事件组,比较两组的基本信息、影像学检查、肿瘤特征、手术过程、围术期并发症及术后随访情况。组间比较采用t检验和χ2检验。采用logistic回归分析术后不良事件发生的危险因素。结果242例单侧CBT患者中,67例发生不良事件(不良事件组),175例未发生不良事件(无不良事件组)。不良事件组包括术后脑卒中合并神经损伤2例,其中1例好转后出院,另1例住院期间死亡;完全切除14个月后发生髂骨转移行放疗后随访期间死亡1例;术后肿瘤复发合并神经损伤2例;单纯神经损伤62例。无不良事件组与不良事件组在一般资料、ShamblinⅡ型CBT占比、肿瘤最大直径、颈内动脉重建方面比较,差异无统计学意义(P均>0.05)。无不良事件组中ShamblinⅠ型CBT占比高于不良事件组,而无不良事件组中ShamblinⅢ型CBT占比、肿瘤体积、颈外动脉结扎、出血量、CBT伴病理性纤维化占比方面低于不良事件组,差异均有统计学意义(P均<0.05)。进一步的回归分析显示CBT伴病理性纤维化以及Shamblin分型高是术后不良事件发生的独立危险因素。结论CBT伴病理性纤维化以及Shamblin分型是预测CBT患者手术切除术后发生不良事件的独立危险因素。

Objective To investigate risk factors for adverse events(stroke,all-cause mortality,recurrence,distant metastasis and nerve injury)after carotid body tumor(CBT)resection.Methods A total of 242 patients with unilateral CBT who had undergone CBT resection and pathological section in Zhongshan Hospital affiliated with Fudan University from June 2007 to May 2020 were retrospectively reviewed.Based on the postoperative condition,the patients were divided into adverse events group and non-adverse events group.The basic information,radiological examination results,tumor characteristics,procedural details,perioperative complications,and postoperative follow-up situations of the two groups were compared.Two-tailed t-test and chi-square test were used for comparison between the two groups.Logistic regression analysis was used to analyze the risk factors for the occurrence of adverse events.Results Of 242 patients with unilateral CBTs,67 had adverse events(adverse events group)and 175 had non-adverse events(non-adverse events group).Adverse events group included 2 patients suffered from postoperative stroke combined with nerve injury,one of them recovered well and the other one died during hospitalization;1 patient suffered from iliac bone metastasis 14 months after undergoing gross total resection and died during follow-up after radiotherapy;2 patients suffered from tumor recurrence complicated with nerve injury;and 62 patients suffered from nerve injury only.There was no significant difference in the basic information,proportion of ShamblinⅡCBT,the maximum tumor diameter,and the proportion of internal carotid artery reconstruction between two groups(all P>0.05).The proportion of ShamblinⅠCBT was significantly higher in the non-adverse events group than that in the adverse events group(P<0.01).However,the proportion of ShamblinⅢCBT,the average volume of CBT,the proportion of patients received external carotid artery ligation,estimated blood loss,and the proportion of CBT with pathological fibrosis were significantly lower in the non-adverse events group than those in the adverse events group(all P<0.05).Further logistic regression analysis revealed that CBT with pathological fibrosis and high Shamblin grades were independent risk factors for postoperative adverse events.Conclusions Pathological fibrosis and Shamblin classification are independent risk factors for predicting postoperative adverse events after CBT resection in CBT patients.