Peritumoral Edema Is Associated With Postoperative Hemorrhage and Reoperation Following Vestibular Schwannoma Surgery.
Peritumoral Edema Is Associated With Postoperative Hemorrhage and Reoperation Following Vestibular Schwannoma Surgery.
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瘤周水肿与前庭神经鞘瘤手术后出血和再次手术有关
DOI：
10.3389/fonc.2021.633350
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发表时间：
2021
影响因子：
4.7
通讯作者：
Hong Y
中科院分区：
文献类型：
--
作者：
Guo X;Zhu Y;Wang X;Xu K;Hong Y
背景：术后出血（POH）是前庭神经鞘瘤手术后的严重并发症，可能需要手术治疗。本研究的目的是确定与前庭神经鞘瘤切除后POH和再手术相关的危险因素。方法：回顾性分析452例经乙状窦后入路治疗的前庭神经鞘瘤患者。主要结局为POH，次要结局为POH再次手术。对临床和影像学资料进行单因素分析和Logistic回归分析。结果如下：在452例患者中，37例（8.2%）出现POH，14例（3.1%）在30天住院期内需要再次手术。单因素分析显示，瘤周水肿、肿瘤直径>30 mm、术后严重高血压和住院时间与POH和POH再手术相关。Logistic回归分析显示，瘤周水肿[OR 4.042，95% CI 1.830-8.926，P = 0.001]和肿瘤直径>30 mm（OR 3.192，95% CI 1.421-7.168，P = 0.005）是POH的独立预测因素。Logistic回归分析显示，瘤周水肿（OR 7.071，95% CI 2.342-21.356，P = 0.001）是再次手术的独立预测因素。进一步分析显示，较大的肿瘤和不完全的肿瘤切除都与较高的瘤周水肿发生率相关。结论：瘤周水肿和肿瘤大小是前庭神经鞘瘤术后POH的独立危险因素。较大的血肿更常见于瘤周水肿的肿瘤，可能需要再次手术。肿瘤大小和肿瘤切除范围与瘤周水肿相关。应密切关注高危患者，特别是那些出现严重术后高血压的患者。
Background: Postoperative hemorrhage (POH) is a severe complication following vestibular schwannoma surgery that may require surgical treatment. The purpose of our study is to identify risk factors associated with POH and reoperation following the resection of vestibular schwannoma. Methods: We retrospectively recruited 452 vestibular schwannoma patients treated with retrosigmoid approach. The primary outcome was POH, and the secondary outcome was reoperation for POH. Clinical and radiographic data were compared by performing univariate analysis and logistic regression analysis. Results: Among the 452 patients, 37 patients (8.2%) presented with POH and14 patients (3.1%) required reoperation within a 30-day hospitalization period. The univariate analysis showed that peritumoral edema, tumor diameter >30 mm, severe postoperative hypertension, and length of hospital stay were associated with POH and reoperation for POH. Logistic regression analysis showed that peritumoral edema [odds ratio (OR) 4.042, 95% confident interval (CI) 1.830–8.926, P = 0.001] and tumor diameter >30 mm (OR 3.192, 95% CI 1.421–7.168, P = 0.005) were independent predictive factors for POH. Peritumoral edema (OR 7.071, 95% CI 2.342–21.356, P = 0.001) was an independent predictive factor for reoperation by using logistic regression analysis. Further analysis revealed that larger tumor and incomplete tumor resection were both associated with a higher incidence of peritumoral edema. Conclusion: Peritumoral edema and tumor size are independent risk factors for POH following vestibular schwannoma surgery. And larger hematoma occurs more commonly in tumors with peritumoral edema which may require reoperation. Tumor size and extent of tumor resection are associated with peritumoral edema. Close attention should be paid to high-risk patients especially for those who presented with severe postoperative hypertension.
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