Zhang Liuzhe, Michihata Nobuaki, Matsui Hiroki, Fushimi Kiyohide, Yasunaga Hideo, Tsuda Yusuke, Tanaka Sakae, Kobayashi Hiroshi
Department of Orthopedic Surgery, The University of Tokyo, Tokyo, Japan.
Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Jpn J Clin Oncol. 2022 Oct 6;52(10):1176-1182. doi: 10.1093/jjco/hyac100.
Massive intraoperative blood loss is common in pelvic malignant bone tumor surgery, and preoperative arterial embolization may be used in selected cases. Preoperative arterial embolization reportedly increases wound complications in pelvic fracture surgery, but little evidence is available regarding pelvic bone tumor surgery.
Using a Japanese nationwide database (Diagnosis Procedure Combination database), we searched for patients who underwent pelvic malignant bone tumor surgery between July 2010 and March 2018. The primary endpoint was wound complications, defined as any wound requiring re-operation, negative pressure wound therapy or both. Univariate analyses (the chi-squared test for categorical variables, the unpaired t-test for continuous variables) and multivariate logistic regression analyses were performed to examine the association between preoperative arterial embolization and wound complications.
Among the 266 eligible patients, 43 (16%, 43/266) underwent embolization and 69 (26%, 69/266) developed wound complications. In the univariate analyses, preoperative arterial embolization (P < 0.001), duration of anesthesia (P < 0.001), the volume of blood transfusion (P < 0.001) and duration of indwelling drain tube (P < 0.001) were associated with wound complications. In the multivariate logistic regression analysis, preoperative arterial embolization was significantly associated with wound complications (odds ratio, 3.92; 95% confidence interval, 1.80-8.56; P = 0.001).
Preoperative arterial embolization may be associated with increased wound complications after pelvic malignant tumor surgery.
盆腔恶性骨肿瘤手术中大量术中失血很常见，在某些特定病例中可采用术前动脉栓塞术。据报道，术前动脉栓塞术会增加骨盆骨折手术的伤口并发症，但关于盆腔骨肿瘤手术的证据很少。
利用日本全国性数据库（诊断程序组合数据库），我们搜索了2010年7月至2018年3月期间接受盆腔恶性骨肿瘤手术的患者。主要终点是伤口并发症，定义为任何需要再次手术、负压伤口治疗或两者皆需的伤口。进行单因素分析（分类变量采用卡方检验，连续变量采用非配对t检验）和多因素逻辑回归分析，以检验术前动脉栓塞与伤口并发症之间的关联。
在266例符合条件的患者中，43例（16%，43/266）接受了栓塞术，69例（26%，69/266）出现了伤口并发症。在单因素分析中，术前动脉栓塞（P<0.001）、麻醉持续时间（P<0.001）、输血量（P<0.001）和留置引流管持续时间（P<0.001）与伤口并发症相关。在多因素逻辑回归分析中，术前动脉栓塞与伤口并发症显著相关（比值比，3.92；95%置信区间，1.80-8.56；P=0.001）。
术前动脉栓塞术可能与盆腔恶性肿瘤手术后伤口并发症增加有关。
