COMPLICAȚIILE CHIRURGIEI GLIOAMELOR
DOI:
https://doi.org/10.52692/1857-0011.2021.3-71.22Cuvinte cheie:
neoplasm cerebral, tumoare cerebrală, gliom, complicații, neurochirurgieRezumat
Introducere. În prezent rezecția radicală este opținea chirurgicală cea mai bună în tratamentul glioamelor cerebrale.Riscul complicațiilor operatorii nu trebuie să prevaleze asupra beneficiilor obținerii unei rezecții totale, mai ales în cazuri de localizare a tumorii în proximitatea regiunilor elocvente.
Scop. Obiectivul studiului a fost de a analiza publicațiile recente consacrate tratamentului chirurgical al tumorilor
gliale cu evidențierea complicațiilor, cauzelor, factorilor de risc dar și a metodelor moderne de reducere a frecvenței acestora.Review-ul dat tinde să consolideze cunoștințele despre morbiditatea postoperatorie, măsurile de prevenire dar și să stabilească eficacitatea utilajului contemporan în ameliorarea rezultatelor tratamentului neurochirurgical.
Material. A fost efectuată o analiză a complicațiilor postoperatorii la pacienții cu tumori gliale. Sursele bibliografice au fost selectate în baza cuvintelor cheie ”neoplasm cerebral”, ”tumoare cerebrală”, ”gliom” și ”complicații”. Au fost incluse în cercetare lucrările care au scos la iveală rata complicațiilor. Au fost luate în considerație particularitățile anatomice, fiziologice, clinice, la fel ca și metodele contemporane de investigații.
Rezultate. Rata totală a complicațiilor documentate este de 10%-35%, iar cea a mortalității 1,0%-15%. Analiza loturilor
de pacienți operați pentru gliom malign a determinat prezența cel puțin a unei complicații chirurgicale în 3,4% și un risc de 4,5% de apariție a complicațiilor spitalicești. Apariția unui deficit neurologic nou sau accentuarea unui existent s-a dovedit în până la 20% fiind cel mai frecvent în cazuri de localizare a glioamelor în ariile elocvente. Complicații dese sunt edemul perilezional (2%-10%), fistula lichidiană (1%-15%), infecția de plagă (0%-4%), hematom postoperator (1%-5%), și convulsiile din perioada postoperatorie precoce (1%-12%). Riscul complicațiilor cardiace este de 0.7%, complicațiilor respiratorii -0.5%, infecțiilor profunde de plagă - 0.8%, trombozei venoase profunde - 0.6%, embolismului pulmonar - 3.1%, insuficienței renale acute - 1.3%. Localizarea infratentorială a tumorii, reoperațiile și radioterapia anterior efectuată au impact asupra incidenței complicațiilor regionale. Vârsta peste 60 ani și comorbiditățile severe sunt factori de risc pentru complicații sistemice.
Concluzii. Morbiditatea postoperatorie în chirurgia tumorilor gliale poate fi redusă prin: încurajarea utilizării protocoalelor standardizate pentru complicațiile regionale și sistemice; neuronavigare, care permite efectuarea unei rezecții maximale păstrând funcționalitatea neurologică; vigilență clinică și atenție la detalii.
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