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Intraoperative Repair of Cerebrospinal Fluid Rhinorrhea in Skull Base Tumor Resection: A Retrospective Study of Acellular Dermal Matrix Versus Turbinate Flap.

颅底肿瘤切除术中脑脊液流涕的术中修复: 脱细胞真皮基质与鼻甲瓣的回顾性研究。

  • 影响因子:1.52
  • DOI:10.1016/j.wneu.2019.08.245
  • 作者列表:"Zhong B","Song NY","Deng D","Li LK","Du JT","Liu F","Liu YF","Liu SX
  • 发表时间:2020-01-01
Abstract

BACKGROUND:The acellular dermal matrix (ADM) and turbinate flap (TF) have been widely used in the reconstruction of skull base defects. However, owing to the lack of reported data, the therapeutic effects have been controversial. The purpose of the present study was to compare the effect of the ADM and TF on cerebrospinal fluid (CSF) rhinorrhea after nasal endoscopic resection of a skull base tumor. METHODS:The data from 46 patients who had undergone nasal endoscopic resection of a skull base tumor and repair of CSF rhinorrhea were retrospectively analyzed. The patients were divided into ADM and TF groups according to the difference in repair materials used. We compared and analyzed the intraoperative information and postoperative outcomes. RESULTS:The operation time, blood loss, defect area, and need for blood transfusion were not significantly different between the ALT and TF groups. The postoperative length of hospital stay (14.33 ± 3.66 vs. 16.76 ± 5.51 days; P = 0.669) and the incidence of complications, including wound infection (1 vs. 0; P = 0.270), intracranial infection (1 vs. 1; P = 0.900), hemorrhage (2 vs. 3; P = 0.788), 15-day CSF leak (1 vs. 2; P = 0.658), and respiratory infection (2 vs. 1; P = 0.450) were comparable between the 2 groups. The 6-month (0 vs. 0; P = 1.000) and 12-month (0 vs. 0; P = 1.000) incidence of recurrence also showed no significant differences. CONCLUSION:The use of the ADM for patients with CSF rhinorrhea showed comparable results in terms of postoperative outcomes compared with the use of TF. ADM could serve as a safe and feasible alternative for endoscopic repair of CSF rhinorrhea after nasal endoscopic resection of skull base tumors.

摘要

背景: 脱细胞真皮基质 (ADM) 和鼻甲瓣 (TF) 已广泛应用于颅base缺损的重建。然而,由于缺乏报告数据,治疗效果一直存在争议。本研究的目的是比较ADM和TF对鼻内镜下颅base肿瘤切除术后脑脊液 (CSF) 流涕的影响。 方法: 回顾性分析 46 例鼻内镜下颅base肿瘤切除加脑脊液流涕修补患者的临床资料。根据所用修复材料的不同将患者分为ADM和TF两组。我们比较分析了术中信息和术后结果。 结果: ALT组和TF组在手术时间、出血量、缺损面积、需要输血等方面差异无统计学意义。术后住院时间 (1 4.33 ± 3.66 vs. 1 6.76 ± 5.5 1 天; P = 0.669) 和并发症发生率,包括伤口感染 (1 vs. 0; P = 0。2 7 0) 、颅内感染 (1 vs. 1; P = 0。9 0 0) 、出血 (2 vs. 3; P = 0.788) 、2 组间 1 例 5 天CSF漏 (1 例vs. 2 例; P = 0.658) 和呼吸道感染 (2 例vs. 1 例; P = 0.450) 具有可比性。6 个月 (0 vs. 0; P = 1。0) 和 12 个月 (0 vs. 0; P = 1。0) 的复发率也无显著差异。 结论: 与使用TF相比,使用ADM治疗CSF流涕患者的术后结果具有可比性。ADM可作为鼻内镜下颅base肿瘤切除术后脑脊液流涕的一种安全可行的替代方法。

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影响因子:1.41
发表时间:2020-03-01
DOI:10.1177/1078155219842277
作者列表:["Gyori DJ","Bullington SM","Crawford BS","Vernon VP"]

METHODS:BACKGROUND:National guidelines recommend screening and treatment for cancer-related bone disease and continued monitoring of bone-modifying agents. It is unclear whether a standardized screening tool is utilized to identify eligible patients and ensure appropriate supportive care is implemented. The purpose of this study was to evaluate current prescribing practices and optimize management of bone-modifying agents. METHODS:A retrospective chart review was performed to identify patients who received hormone deprivation therapy or had bone metastases through Hematology/Oncology or Urology clinics from 1 November 2016 to 31 October 2017. The primary endpoints of this study were the incidence of completed baseline dual-energy X-ray absorptiometry (DEXA) scan for patients on hormone deprivation therapy and percent of patients started on a bone-modifying agent for the prevention of skeletal-related events secondary to bone metastasis. Secondary endpoints included percent of patients with dental examinations prior to initiation, adequate calcium and vitamin D supplementation, incidence of osteonecrosis of the jaw or flu-like symptoms and education, and percent of bisphosphonate doses appropriately adjusted based on renal function. RESULTS:A total of 375 patients were assessed for baseline DEXA scans and bone-modifying therapy. Of the 226 patients on hormone deprivation therapy, 111 (49%) patients were appropriately screened with a DEXA scan prior to initiation of hormone deprivation therapy. Among the 149 patients with bone metastases, only 94 (63.1%) patients were started on a bone-modifying agent. CONCLUSIONS:Opportunities have been identified to optimize management of patients with cancer-related bone disease. Implementation of standardized tools may increase the rate of appropriate screening and initiation of bone-modifying therapy when warranted.

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影响因子:2.83
发表时间:2020-01-01
DOI:10.1007/s00520-019-04843-9
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骨肿瘤方向

骨肿瘤是发生于骨骼或其附属组织的肿瘤。有良性,恶性之分,良性骨肿瘤易根治,预后良好,恶性骨肿瘤发展迅速,预后不佳,死亡率高。

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