Kobayashi Kenya, Matsumoto Fumihiko, Miyakita Yasuji, Arikawa Masaki, Omura Go, Matsumura Satoko, Ikeda Atsuo, Sakai Azusa, Eguchi Kohtaro, Narita Yoshitaka, Akazawa Satoshi, Miyamoto Shimpei, Yoshimoto Seiichi
Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan.
Department of Neurosurgery and Neuro-oncology, National Cancer Center Hospital, Tokyo, Japan.
Biomed Hub. 2020 Jul 7;5(2):87-100. doi: 10.1159/000507750. eCollection 2020 May-Aug.
To determine factors that delay surgical recovery and increase intraoperative hemorrhage in skull base surgery.
Factors related to delayed postoperative recovery were retrospectively reviewed in 33 patients who underwent open skull base surgery. Early and late recovery phases were assessed as "days required to walk around the ward (DWW)" and "length of hospital stay (LHS)," respectively. Intraoperative blood loss was cal-culated every hour and analyzed in 4 steps, i.e., craniotomy and intracranial manipulation, cranial fossa osteotomy, extracranial osteotomy, and reconstruction.
More than 4,000 mL of blood loss ( = 2.7392, Exp[] = 15.4744; 95% CI 1.1828-202.4417) and comorbidi-ty ( = 2.3978, Exp[]) = 10.9987; 95% CI 1.3534-98.3810) significantly prolonged the DWW; the occurrence of postoperative complications significantly delayed the LHS ( = 0.0316). Tumor invasion to the hard palate, the maxillary sinus, the pterygopalatine fossa, the base of the pterygoid process, the sphenoid sinus, the middle cranial fossa, and the cavernous sinus and a long operation time (>13 h) were associated with increased total hemorrhage. The optimal cut-off hemorrhage volume associated with total massive blood loss in craniotomy and intracranial manipulation (AUC = 0.8364), cranial fossa osteotomy (AUC = 0.8000), and extracranial osteotomy (AUC = 0.8545) was 1,111, 750, and 913 mL, respectively. Persistent infection (6%) and neuropsychiatric disorder (6%) are direct causes of delayed LHS.
Blood loss, comorbidity, and postoperative complications were risk factors for delayed surgical recovery. Meticulous preoperative planning, intraoperative surefire hemostasis, and perioperative holistic management are prerequisites for safe skull base surgery.
确定影响颅底手术术后恢复延迟及术中出血增加的因素。
对33例行开放性颅底手术的患者进行回顾性分析，以确定与术后恢复延迟相关的因素。早期和晚期恢复阶段分别以“在病房内行走所需天数（DWW）”和“住院时间（LHS）”进行评估。术中每小时计算失血量，并分4个步骤进行分析，即开颅及颅内操作、颅窝截骨、颅外截骨和重建。
失血量超过4000 mL（ = 2.7392，Exp[] = 15.4744；95%可信区间1.1828 - 202.4417）和合并症（ = 2.3978，Exp[] = 10.9987；95%可信区间1.3534 - 98.3810）显著延长DWW；术后并发症的发生显著延迟LHS（ = 0.0316）。肿瘤侵犯硬腭、上颌窦、翼腭窝、翼突基部、蝶窦、中颅窝和海绵窦以及手术时间长（>13小时）与总出血量增加相关。开颅及颅内操作（AUC = 0.8364）、颅窝截骨（AUC = 0.8000）和颅外截骨（AUC = 0.8545）中与大量失血相关的最佳失血量截断值分别为1111、750和9,13 mL。持续感染（6%）和神经精神障碍（6%）是LHS延迟的直接原因。
失血量、合并症和术后并发症是手术恢复延迟的危险因素。细致的术前规划、术中可靠的止血和围手术期的整体管理是安全颅底手术的前提条件。
