Dias F L, Sá G M, Kligerman J, Lopes H F, Wance J R, Paiva F P, Benévolo A, Freitas E Q
Head and Neck Surgery Service, Hospital do Cancer/INCa, Rio de Janeiro, Brazil.
Head Neck. 1999 Jan;21(1):12-20. doi: 10.1002/(sici)1097-0347(199901)21:1<12::aid-hed2>3.0.co;2-#.
The complications associated with anterior craniofacial resections for benign and malignant tumors were reviewed in 104 patients treated between January 1981 and June 1996.
Information regarding patient characteristics, histologic type, history of prior therapy, extent of the disease, extent of surgical procedure, and type of reconstruction were entered in a microcomputer database. To better understand and stage postoperative complications, we divided them into early (<14 days) and late (>14 days) according to the time of presentation, into major and minor depending on the morbidity potential of complication, and into local and systemic ones. Comparison between risk factors associated with complications was made using chi-square analysis with Yates' correction for continuity. Survival analysis was performed using the Kaplan-Meier product limit method.
There were 8 (7.6%) postoperative deaths, with only 1 occurring from systemic complications. Complications occurred in 53 (48.6%) patients. Local major complications occurred in 49 (45%) patients, local minor in 29 (26.6%), and systemic in 11 (10%). Early complications occurred in 40 (38.5%) patients and late complications in 13 (12.5%) patients. These complications developed during a period ranging from 1 day to 5 months. More than one complication occurred in a number of patients. Bacterial contamination leading to local septic complications was the principal cause of morbidity, accounting for 54.7% (29/53) of complications. Major complications included meningitis in 8 patients associated with cerebrospinal fluid leak in 7, cerebral abscess in 2, sepsis in 1, and subdural hemorrhage in 1, all of which resulted in death except for one case. The extent of the craniofacial resection (p = .011) was the most important factor associated with major complications. Invasion of the dura and the type of reconstruction of the anterior skull base were the most important factors related to cerebrospinal fluid leakage (p = .048 and p = .032) and meningitis (p = .011).
Contemporary surgical approaches and methods of reconstruction have enabled skull base surgeons to extend their cranial base resections and increase the 5-year survival rates of patients. Nevertheless, significant complications persist. Knowledge and high index of suspicion together with early recognition of these complications are essential for effective management of patients undergoing craniofacial resection. The factors related to major complications found in this study stressed the need to develop more effective methods to prevent contamination of intracranial structures.
回顾了1981年1月至1996年6月间接受治疗的104例因良性和恶性肿瘤而行前颅面切除术患者的相关并发症情况。
将有关患者特征、组织学类型、既往治疗史、疾病范围、手术范围及重建类型等信息录入微机数据库。为更好地理解和分期术后并发症，我们根据出现时间将其分为早期（<14天）和晚期（>14天），根据并发症的潜在发病率分为严重和轻微，以及分为局部和全身并发症。采用连续性校正的卡方分析对与并发症相关的危险因素进行比较。使用Kaplan-Meier乘积限界法进行生存分析。
术后死亡8例（7.6%），仅1例死于全身并发症。53例（48.6%）患者发生并发症。49例（45%）患者发生局部严重并发症，29例（26.6%）发生局部轻微并发症，11例（10%）发生全身并发症。40例（38.5%）患者发生早期并发症，13例（12.5%）患者发生晚期并发症。这些并发症发生时间从1天至5个月不等。一些患者发生不止一种并发症。导致局部感染性并发症的细菌污染是发病的主要原因，占并发症的54.7%（29/53）。严重并发症包括8例脑膜炎，其中7例伴有脑脊液漏，2例脑脓肿，1例败血症，1例硬膜下出血，除1例存活外其余均导致死亡。颅面切除术的范围（p = 0.011）是与严重并发症相关的最重要因素。硬脑膜侵犯及前颅底重建类型是与脑脊液漏（p = 0.048和p = 0.032）和脑膜炎（p = 0.011）相关的最重要因素。
当代手术方法和重建技术使颅底外科医生能够扩大颅底切除术范围并提高患者的5年生存率。然而，严重并发症仍然存在。了解并高度怀疑这些并发症以及早期识别对于有效管理接受颅面切除术的患者至关重要。本研究中发现的与严重并发症相关的因素强调了开发更有效方法预防颅内结构污染的必要性。
