Clinical Characteristics And Risk Factors Of Hemorrhage Complicated With Postoperative Vein Occlusion Of Cerebral Tumor

Context:Hemorrhage complicated with postoperative vein occlusion of cerebral tumor is a severe form of special type of intracranial neoplasm postoperative complication. Its clinical manifestations are nonspecific, its causes are numerous, and it's with high rate of mortality and disability. Due its clinical low morbidity rate, once the complication occurs, we often lack the effective treatment. Presently, there is no targeted related report about this complication. By researching 100 cases of patients of the neurosurgery department, Bethune the first hospital of Jilin University between June 2008 and December 2010, who were suffered with intracranial neoplasm with surgery, we made an analysis retrospectively about the clinical data, first put forward this concept. We take 10 of the cases which are positive with this complication as a positive group, the rest 90 cases did not occur this complication negative group, making the statistical analysis of the cases and puts forward the significant risk factors and dangerous factors that may exist but is not statistically proved.Objective:Explore the pathogenesis and susceptibility of hemorrhage complicated with postoperative vein occlusion of cerebral tumor, summarize key points of therapy and diagnosis, assess the prognosis.Material and methods:Between June 2008 and December 2010 the neurosurgery department of Bethune the first hospital of Jilin University there were 10 cases suffered with this complication, other cases with no complication were randomly chosen as control group. All of 100 patients are in general anesthesia microsurgical resection. Preoperative we made comprehensive assessment about sizes, inolement parts of tumor, state of patients, et al. for choosing different surgical approach.We respectively recorded patients'name, age, whether they have heavier degree of hypertension, coronary heart disease or diabetes history, whether they have long-term use of blood anticoagulant medicine, whether they suffered from vasculitis or other autoimmune diseases with long-term hormone taking history, whether the hemorrhage complicated with postoperative vein occlusion of cerebral tumor occured. Towards the risk factors may influence the occurrence, we first made a single factor Logistic regression analysis, parameters with P < 0.05 were put into multi-factor Logistic regression analysis.Statistical analysis by SAS system, measurement data with two variables (1/0), statistics processing with chi-square and Fisher accurate test, we put risk factors confirmed by single factor Logistic regression analysis backward, made a multiple factors Logistic regression analysis. Count data to frequency and (or) percentage (%) with a chi-square test statistical processing, take P < 0.05 for a statistically significant difference.Results:8 cases of the 10 patients have clear intraoperative occlusion damage of important vein in operation district. All cases showed immediate or appearing within 3 days different degree disorders of nervous functions or (and) consciousness obstacle, dynamic review strongly suggest that the head CT widely scattered melanoma in merger internal edema patchy bleeding, local mass effect point significantly. 6 patients need to the reoperation to remove injury with bone disc decompression, 1 patients with cerebral hernia caused death. Follow-up of 3-22 months, 3 cases left limbs upon, 2 cases left light intractable seizures (need long-term orally antiepileptic drug control), the above can achieve self-care.In 100 patients, group of 10 patients in whether heavier history of diabetes, hypertension and coronary heart disease, whether had vasculitis autoimmune diseases with long-term hormone taking history as compared with control is without significant difference (P > 0.05). And the patient's age, whether they have long-term use of anticoagulation drugs is significantly higher than that in control group (P < 0.05). Using SAS system for single factor Logistic regression analysis of the possible effects of complications have risk factors for > = 60 namely age, long-term use of anticoagulation drugs we made Logistic regression analysis. Multiple factor Logistic regression analysis shows that the high age, long-term use of anticoagulant drugs have significant correlation with whether patients suffered from hemorrhage complicated with postoperative vein occlusion of cerebral tumor.Conclusion:1. Hemorrhage complicated with postoperative vein occlusion of cerebral tumor is one of the most serious complications, early head CT with a characteristic can be used as a performance of the disease diagnosis points.2. Early big doses of hormones and improve microcirculation drug therapy can help stabilize the illness.3. Because uncontrollable tumor edema and cerebral hernia tendency, more than 50% of patients will require reoperation, and will bequeath different degrees of permanent neural function lost.4. Older age, heavier degree of high blood pressure, coronary heart disease and diabetes history, long-term use of blood anticoagulation drugs and suffering from vasculitis and other autoimmune diseases with long-term hormone taking history is the risk factors of hemorrhage complicated with postoperative vein occlusion of cerebral tumor. Among them, the elderly, long-term use of blood anticoagulation drugs, by statistical analysis results confirmed as significant risk factor.5. The preoperative MRV check with melanoma provided, intraoperative exact veins operation, para-tumor venous anatomical protection is the only effective means to avoid this perioperative complications.