New predictors of complications in carotid body tumor resection
New predictors of complications in carotid body tumor resection
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DOI：
10.1016/j.jvs.2016.12.124
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发表时间：
2017-06-01
影响因子：
4.3
通讯作者：
Farber, Alik
中科院分区：
文献类型：
--
作者：
Kim, Gloria Y.;Lawrence, Peter F.;Farber, Alik
目的：本研究探讨了肿瘤到颅底距离 (DTBOS) 和肿瘤体积这两个新变量与颈动脉体肿瘤 (CBT) 切除并发症（包括出血和颅神经损伤）之间的关系。 方法：使用标准化、多机构数据库对 2004 年至 2014 年间接受 CBT 切除术的患者进行研究。收集人口统计学、围手术期和结果数据。 CBT 测量结果通过计算机断层扫描、磁共振成像和超声检查确定。结果：332 名患者切除了 356 个 CBT（平均年龄 51 岁；72% 为女性）； 32% 被归类为 Shamblin I，43% 被归类为 Shamblin II，23% 被归类为 Shamblin III。平均 DTBOS 为 3.3 cm（标准差 [SD]，2.1；范围，0-10），平均肿瘤体积为 209.7 cm(3)（SD，266.7；范围，1.1-1642.0 cm(3)）。平均估计失血量 (EBL) 为 257 mL（SD，426；范围，0-3500 mL）。百分之二十四的患者有脑神经损伤。最常见的脑神经损伤是舌下神经（10%）、迷走神经（11%）和喉上神经（5%）。 Shamblin 分级和 DTBOS 均与手术和颅神经损伤的 EBL 显着相关，而肿瘤体积与 EBL 显着相关。使用所有三个变量（Shamblin、DTBOS 和容量（R-2 分别 = 0.171、0.221））预测失血和颅神经损伤的逻辑模型优于单独使用 Shamblin 的模型（R-2 分别 = 0.043、0.091）。调整 Shamblin 分级和体积后，DTBOS 每减少 1 厘米，失血量 > 250 mL 的风险就会增加 1.8 倍（95% 置信区间，1.25-2.55），颅神经损伤的风险增加 1.5 倍（95% 置信区间，1.19-1.92）。 结论：这项大型 CBT 研究证明了术前确定肿瘤尺寸的价值以及术前确定肿瘤尺寸的价值。 肿瘤位于颅底。 DTBOS 和肿瘤体积与 Shamblin 分级结合使用时，可以更好地预测出血和颅神经损伤风险。此外，在向颅底扩张之前进行手术切除可以减少并发症，因为距颅底的距离每减少 1 厘米，就会导致失血量增加 1.8 倍（>250 mL），并且颅神经损伤的风险增加 1.5 倍。
Objective: This study examined the relationship between two new variables, tumor distance to base of skull (DTBOS) and tumor volume, with complications of carotid body tumor (CBT) resection, including bleeding and cranial nerve injury.Methods: Patients who underwent CBT resection between 2004 and 2014 were studied using a standardized, multi-institutional database. Demographic, perioperative, and outcomes data were collected. CBT measurements were determined from computed tomography, magnetic resonance imaging, and ultrasound examination.Results: There were 356 CBTs resected in 332 patients (mean age, 51 years; 72% female); 32% were classified as Shamblin I, 43% as Shamblin II, and 23% as Shamblin III. The mean DTBOS was 3.3 cm (standard deviation [SD], 2.1; range, 0-10), and the mean tumor volume was 209.7 cm(3) (SD, 266.7; range, 1.1-1642.0 cm(3)). The mean estimated blood loss (EBL) was 257 mL (SD, 426; range, 0-3500 mL). Twenty-four percent of patients had cranial nerve injuries. The most common cranial nerves injured were the hypoglossal (10%), vagus (11%), and superior laryngeal (5%) nerves. Both Shamblin grade and DTBOS were statistically significantly correlated with EBL of surgery and cranial nerve injuries, whereas tumor volume was statistically significantly correlated with EBL. The logistic model for predicting blood loss and cranial nerve injury with all three variables-Shamblin, DTBOS, and volume (R-2 = 0.171, 0.221, respectively)-was superior to a model with Shamblin alone (R-2 = 0.043, 0.091, respectively). After adjusting for Shamblin grade and volume, every 1-cm decrease in DTBOS was associated with 1.8 times increase in risk of >250 mL of blood loss (95% confidence interval, 1.25-2.55) and 1.5 times increased risk of cranial nerve injury (95% confidence interval, 1.19-1.92).Conclusions: This large study of CBTs demonstrates the value of preoperatively determining tumor dimensions and how far the tumor is located from the base of the skull. DTBOS and tumor volume, when used in combination with the Shamblin grade, better predict bleeding and cranial nerve injury risk. Furthermore, surgical resection before expansion toward the base of the skull reduces complications as every 1-cm decrease in the distance to the skull base results in 1.8 times increase in >250 mL of blood loss and 1.5 times increased risk of cranial nerve injury.