目的:用于肿瘤切除的开颅手术有时会导致伤口并发症,这在神经肿瘤患者的治疗中可能是毁灭性的。最近引入了颅骨阶梯技术作为减轻这些并发症的方法,特别是在这些患者人群中,他们经常表现出额外的危险因素,包括类固醇,放化疗,和VEGF抑制剂治疗。这项研究通过使用与标准开颅手术伤口闭合匹配的倾向评分比较其术后并发症来评估我们的颅骨阶梯方法。
方法:对在单一机构接受原发性开颅手术的颅内肿瘤患者进行回顾性分析。排除先前开颅手术和少于三个月随访的患者。使用RStudio进行分析。
结果:383例患者被纳入研究,其中139人接受了阶梯技术,其余人接受了传统的开颅手术闭合。阶梯队列年龄较大,有更高的ASA等级,冠状动脉疾病的患病率较高。阶梯患者之前服用类固醇较少(40.29%vs.56.56%,p<0.01)和手术后(87.05%vs.94.26%,p=0.02),更少的免疫疗法(12.95%vs.20.90%,p=0.05),但他们在术前接受了更多的辐射(15.11%vs.8.61%,p=0.05)。他们的复发和残差手术也较少(0.72%与10.66%,p=0.01)。在倾向得分匹配上,我们发现111对配对,除随访时间外没有差异(p<0.01)。阶梯组软组织感染较少(0%vs.3.60%,p=0.04),总伤口并发症较少(0%vs.4.50%,p=0.02),为这些并发症进行的手术较少(0%vs.3.60%,p=0.04),并且停留时间较短(6vs.9天,p<0.01)。值得注意的是,我们队列中伤口并发症的平均时间为44天,在我们的排除标准和随访时间内。
结论:颅骨阶梯技术在减少需要开颅手术的神经肿瘤患者的伤口并发症和再手术率方面是安全有效的。
OBJECTIVE: Craniotomies for tumor resection can at times result in wound complications which can be devastating in the treatment of neuro-oncological patients. A cranial stair-step technique was recently introduced as an approach to mitigate these complications, especially in this patient population who often exhibit additional risk factors including steroids, chemoradiation, and VEGF inhibitor treatments. This study evaluates our cranial stair-step approach by comparing its postoperative complications using propensity score matching with those of a standard craniotomy wound closure.
METHODS: A retrospective chart review was conducted on patients with intracranial neoplasms undergoing primary craniotomy at a single institution. Patients with prior craniotomies and less than three months of follow-up were excluded. Analyses were performed using R Studio.
RESULTS: 383 patients were included in the study, 139 of whom underwent the stair-step technique while the rest underwent traditional craniotomy closures. The stair-step cohort was older, had higher ASA classes, and had a higher prevalence of coronary artery disease. The stair-step patients were administered fewer steroids before (40.29% vs. 56.56%, p < 0.01) and after surgery (87.05% vs. 94.26%, p = 0.02), fewer immunotherapy (12.95% vs. 20.90%, p = 0.05), but they received more radiation preoperatively (15.11% vs. 8.61%, p = 0.05). They also underwent fewer operations for recurrences and residuals (0.72% vs. 10.66%, p = 0.01). On propensity score matching, we found 111 matched pairs with no differences except follow-up duration (p < 0.01). The stair-step group had fewer soft tissue infections (0% vs. 3.60%, p = 0.04), fewer total wound complications (0% vs. 4.50%, p = 0.02), was operated on less for these complications (0% vs. 3.60%, p = 0.04), and had a shorter length of stay (6 vs. 9 days, p < 0.01). Notably, the average time to wound complication in our cohort was 44 days, well within our exclusion criteria and follow-up duration.
CONCLUSIONS: The cranial stair-step technique is safe and effective in reducing rates of wound complications and reoperation for neuro-oncologic patients requiring craniotomy.