Sciubba Daniel M, Nelson Clarke, Gok Beryl, McGirt Matthew J, McLoughlin Gregory S, Noggle Joseph C, Wolinsky Jean Paul, Witham Timothy F, Bydon Ali, Gokaslan Ziya L
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
J Neurosurg Spine. 2008 Dec;9(6):593-9. doi: 10.3171/SPI.2008.9.0861.
Resection of sacral tumors has been shown to improve survival, since the oncological prognosis is commonly correlated with the extent of local tumor control. However, extensive soft-tissue resection in close proximity to the rectum may predispose patients to wound complications and infection. To identify potential risk factors, a review of clinical outcomes for sacral tumor resections over the past 5 years at a single institution was completed, paying special attention to procedure-related complications.
Between 2002 and 2007, 46 patients with sacral tumors were treated with surgery. Demographic data, details of surgery, type of tumor, and patient characteristics associated with surgical site infections (SSIs) were collected; these data included presence of the following variables: diabetes, obesity, smoking, steroid use, previous surgery, previous radiation, cerebrospinal fluid leak, number of spinal levels exposed, instrumentation, number of surgeons scrubbed in to the procedure, serum albumin level, and combined anterior-posterior approach. Logistic regression analysis was implemented to find an association of such variables with the presence of SSI.
A total of 46 patients were treated for sacral tumor resections; 20 were male (43%) and 26 were female (57%), with an average age of 46 years (range 11-83 years). Histopathological findings included the following: chordoma in 19 (41%), ependymoma in 5 (11%), rectal adenocarcinoma in 5 (11%), giant cell tumor in 4 (9%), and other in 13 (28%). There were 18 cases of wound infection (39%), and 2 cases of repeat surgery for tumor recurrence (1 chordoma and 1 giant cell tumor). Factors associated with increased likelihood of infection included previous lumbosacral surgery (p = 0.0184; odds ratio [OR] 7.955) and number of surgeons scrubbed in to the operation (p = 0.0332; OR 4.018). Increasing age (p = 0.0864; OR 1.031), presence of complex soft-tissue reconstruction (p = 0.118; OR 3.789), and bowel and bladder dysfunction (p = 0.119; OR 2.667) demonstrated a trend toward increased risk of SSI.
Patients undergoing sacral tumor surgery may be at greater risk for developing wound complications due to the extensive soft-tissue resections often required, especially with the increased potential for contamination from the neighboring rectum. In this study, it appears that previous lumbosacral surgery, number of surgeons scrubbed in, patient age, bowel and bladder dysfunction, and complex tissue reconstruction may predict those patients more prone to developing postoperative SSIs.
骶骨肿瘤切除术已被证明可提高生存率，因为肿瘤学预后通常与局部肿瘤控制程度相关。然而，在直肠附近进行广泛的软组织切除可能使患者易发生伤口并发症和感染。为了确定潜在的风险因素，我们对一家机构过去5年骶骨肿瘤切除术的临床结果进行了回顾，特别关注与手术相关的并发症。
2002年至2007年间，46例骶骨肿瘤患者接受了手术治疗。收集了人口统计学数据、手术细节、肿瘤类型以及与手术部位感染（SSIs）相关的患者特征；这些数据包括以下变量的存在情况：糖尿病、肥胖、吸烟、使用类固醇、既往手术、既往放疗、脑脊液漏、暴露的脊柱节段数、内固定、参与手术的外科医生人数、血清白蛋白水平以及前后联合入路。采用逻辑回归分析来寻找这些变量与SSIs存在之间的关联。
共有46例患者接受了骶骨肿瘤切除术；20例为男性（43%），26例为女性（57%），平均年龄46岁（范围11 - 83岁）。组织病理学结果如下：脊索瘤19例（41%）、室管膜瘤5例（11%）、直肠腺癌5例（11%）、巨细胞瘤4例（9%）、其他13例（28%）。有18例伤口感染（39%），2例因肿瘤复发接受再次手术（1例脊索瘤和1例巨细胞瘤）。与感染可能性增加相关的因素包括既往腰骶部手术（p = 0.0184；比值比[OR] 7.955）和参与手术的外科医生人数（p = 0.0332；OR 4.018）。年龄增加（p = 0.0864；OR 1.031）、存在复杂的软组织重建（p = 0.118；OR 3.789）以及肠道和膀胱功能障碍（p = 0.119；OR 2.667）显示出SSIs风险增加的趋势。
由于通常需要进行广泛的软组织切除，尤其是由于邻近直肠污染的可能性增加，接受骶骨肿瘤手术的患者发生伤口并发症的风险可能更高。在本研究中，既往腰骶部手术、参与手术的外科医生人数、患者年龄、肠道和膀胱功能障碍以及复杂的组织重建似乎可以预测哪些患者更容易发生术后SSIs。
