Hivelin Mikael, Plaud Benoit, Hemery Francois, Boulat Claire, Ortonne Nicolas, Valleyrie-Allanore Laurence, Wolkenstein Pierre, Lantieri Laurent
Paris and Creteil, France.
From the Plastic Surgery Department, Hopital Européen Georges Pompidou, Hôpitaux Universitaires Paris Ouest; Université Paris Descartes; Anesthesiology, Surgical Intensive Care, Hopital Saint Louis, Assistance Publique-Hôpitaux de Paris Universite Paris Diderot, Paris 7; the Medical Cost Department, Blood Bank Department, Pathology Department, and Dermatology Department, Hopital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Universite Paris Est Creteil; and the French Referral Centre for Neurofibromatosis.
Plast Reconstr Surg. 2016 Apr;137(4):700e-711e. doi: 10.1097/PRS.0000000000002021.
Neurofibromas in neurofibromatosis type 1 induce aesthetic and functional morbidity. Perioperative bleeding has been reported as an obstacle to neurofibroma resections. The authors studied the requirement for blood transfusion during surgical treatment of neurofibromatosis type 1.
Six hundred twenty-two procedures performed on 390 neurofibromatosis type 1 patients at the national referral center from 1995 to 2011 were analyzed in two chronologic sets of patients: set 1 (February of 1995 to September of 2007), in which only one surgeon operated; and set 2 (October of 2007 to January of 2011), in which two additional surgeons were involved. Malignant peripheral nerve sheath tumors, reconstructive procedures, and spontaneous hemorrhages were excluded from the analysis. Age, sex, preoperative hemoglobin concentration, location, length, estimated volume and histologic features of the largest neurofibroma (cumulative values for multiple neurofibromas), and procedure duration were studied as potential predictors of blood transfusion that were measured in terms of units of packed red blood cells.
Seventy reconstructive procedures, two cases of spontaneous hemorrhage, and 32 malignant peripheral nerve sheath tumor resections were excluded. Among 516 procedures (318 and 198 in sets 1 and 2, respectively), 17 (2.7 percent) required blood transfusions. The requirement for transfusion was associated with neurofibroma length in both sets, with an optimal cutoff value of 13 cm in both sets.
Contrary to the literature, the requirement for blood transfusion was found to be low (2.7 percent of the cases) during elective resection of neurofibromas in neurofibromatosis type 1. Elective resections of benign neurofibromas less than 13 cm in length were not associated with a requirement for blood transfusion.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
1型神经纤维瘤病中的神经纤维瘤会导致美观和功能方面的问题。围手术期出血已被报道为神经纤维瘤切除手术的一个障碍。作者研究了1型神经纤维瘤病手术治疗期间的输血需求。
对1995年至2011年在国家转诊中心对390例1型神经纤维瘤病患者进行的622例手术进行分析，分为两组按时间顺序排列的患者：第1组（1995年2月至2007年9月），只有一位外科医生进行手术；第2组（2007年10月至2011年1月），另外有两位外科医生参与。分析排除了恶性外周神经鞘瘤、重建手术和自发性出血。研究年龄、性别、术前血红蛋白浓度、位置、长度、最大神经纤维瘤（多个神经纤维瘤的累积值）的估计体积和组织学特征以及手术持续时间，将其作为输血的潜在预测因素，输血以浓缩红细胞单位衡量。
排除了70例重建手术、2例自发性出血病例和32例恶性外周神经鞘瘤切除术。在516例手术中（第1组318例，第2组198例），17例（2.7%）需要输血。两组中输血需求均与神经纤维瘤长度相关，两组的最佳截断值均为13 cm。
与文献报道相反，发现1型神经纤维瘤病患者择期切除神经纤维瘤期间的输血需求较低（2.7%的病例）。长度小于13 cm的良性神经纤维瘤择期切除与输血需求无关。
临床问题/证据水平：风险，III级
