儿童腹膜后畸胎瘤围手术期并发症的危险因素分析

目的儿童腹膜后畸胎瘤围手术期并发症发生率较高。本研究旨在探索围手术期并发症的手术危险因素,以期减少手术并发症。方法回顾性分析2000年5月至2017年12月在广州市妇女儿童医疗中心手术治疗的腹膜后畸胎瘤病例。收集的临床资料包括患儿性别、年龄、体重、主要症状、甲胎蛋白、影像学特征、术中发现、围手术期并发症及病理结果。结果152例腹膜后畸胎瘤患儿均在本院接受手术治疗,其中女童102例,男童50例,中位年龄为5.7个月。152例中63例共发生84起围手术期并发症,并发症发生率为42%。113例有术前CT或MRI影像学资料,分别有112例(99%)、111例(98%)、113例(100%)出现动脉、静脉或器官移位,28例(25%)表现为肿瘤包绕血管。单因素分析提示,年龄>1岁(OR=0.29,95%CI:0.12~0.71)、体重较高(OR=0.87,95%CI:0.78~0.97)的患儿发生围手术期并发症的风险显著降低;静脉移位(OR=1.52,95%CI:1.15~2.00)、器官移位(OR=1.74,95%CI:1.23~2.47)、血管包绕(OR=1.53,95%CI:1.06~2.19)显著增加了围手术期并发症风险;肿瘤跨越中线显著增加围手术期并发症(OR=2.91,95%CI:1.28~6.60);左侧腹膜后畸胎瘤较右侧具有更高的手术风险(OR=2.01,95%CI:0.99~4.08)。多因素Logistic回归分析显示,血管包绕(OR=1.45,95%CI:1.00~2.10)和器官移位数量(OR=1.69,95%CI:1.19~2.41)是围手术期并发症的危险因素。结论儿童腹膜后畸胎瘤围手术期并发症的发生率较高,肿瘤包绕血管或推移器官显著增加手术风险。

Risk factors for perioperative complications of pediatric retroperitoneal teratoma

Objective Pediatric retroperitoneal teratoma is relatively rare.However,its surgical removal is associated with a high occurrence rate of perioperative complications.The present study was intended to explore the features of predicting perioperative complication risks and lowering the perioperative complications.Methods Between May 2000 and December 2017,a total of 152 pediatric retroperitoneal teratomas were resected.There are 102 girls and 50 boys with a median age of 5.7 months.Such patient characteristics as gender,age,weight,clinical symptoms,alpha fetoprotein level,radiographic features,intraoperative findings,pathological results and perioperative complications were analyzed.Results Among them,63/152 children(42%)developed 84 perioperative complications,including 79 intraoperative and 5 postoperative complications.Among 113 children with preoperative CT/MRI data,112(99%),111(98%),113(100%)and 28(25%)had arterial distortion,venous distortion,organ distortion and vascular encasement respectively.Univariate analysis revealed that age>1 year and higher body weight were two preventive factors of perioperative complications(OR=0.29,95%CI:0.12-0.71;OR=0.87,95%CI:0.78-0.97).Venous distortion(OR=1.52,95%CI:1.15-2.00),organ distortion(OR=1.74,95%CI:1.23-2.47),vascular encasement(OR=1.53,95%CI:1.06-2.19),tumors beyond midline(OR=2.91,95%CI:1.28-6.60)and left-sided tumor(OR=2.01,95%CI:0.99-4.08)would elevate the risks of perioperative complications.Based upon multivariate analysis,only vascular encasement(OR=1.45,95%CI:1.00-2.10)and organ distortion(OR=1.69,95%CI:1.19-2.41)were significantly associated with an elevated rate of perioperative complications.Conclusion Resection of pediatric retroperitoneal teratoma is associated with a high incidence of perioperative complications.And vascular encasement and organ distortion are significantly associated with higher surgical risks.