Analysis Of Factors Related To Postoperative Complications Of Sacrococcygeal Teratoma In Children

Objective:Through retrospective analysis of the clinical data of children with sacrococcygeal teratoma,the clinical characteristics were summarized,and the related factors of postoperative complications in children with sacrococcygeal teratoma and the prevention and treatment strategies were discussed.The purpose was to reduce the postoperative complications and improve the quality of life of children,and to provide theoretical basis for the prevention and treatment of postoperative complications of sacrococcygeal teratom.Materials and Methods:From December 2012 to November 2018,73 cases of sacrococcygeal teratoma in pediatric surgery of the First Affiliated Hospital of Zhengzhou University were collected,and the clinical data were collected.At the same time,combined with the relevant literature and using statistical methods,the observation factors that may affect the occurrence of post-operative complications such as sex,age,production,clinical classification,tumor size,tumor characteristics,preoperative serum alpha-fetoprotein(AFP),pathological type and perioperative conditions were selected.This article only discussed the complications such as poor wound healing,anorectal dysfunction and recurrence.Statistical analysis was performed.Result:1.Postoperative complications: Among 73 children undergoing SCT,22 had complications,the overall incidence of complications was 30.14%.Among them,12 had poor wound healing(16.44%,12/73),including 6 cases of subincision effusion(8.22%,6/73),3 cases of incision infection(4.11%,3/73),3 cases of incision dehiscence(4.11%,3/73).Anorectal dysfunction occurred postoperatively.There were 5 cases(6.85%,5/73),including 3 cases of fecal incontinence(4.11%,3/73),2 cases of constipation(2.74%,2/73),and 5 cases of recurrence(6.85%,5/73).During the follow-up period of 1 month to 75 months,7 of 12 children with poor wound healing were treated with antibiotics in time and local wound dressing change,4 children were treated with antibiotic dressing change after discharge,and 1 child was cured with local coverage of negative pressure drainage(VSD)after secondary suture.Up to now,12 children with poor wound healing were cured.Among the relapsed children,1 case was transferred to pediatric medicine department for chemotherapy because of liver metastasis,and the other 4 cases underwent second surgical resection.One case was benign SCT,and the recurrence of primary tumors was found by routine CT scan 1year,11 months after operation.After second surgical resection,one case was immature SCT.The recurrence occurred 18 months after operation.After second surgical resection,the serum AFP and sacrococcygeal MRI were not different.Three cases of malignant SCT recurred locally from 5 months to 2 years after operation.One case underwent palliative surgery because of severe infiltration of surrounding tissues.Liver metastasis occurred in 1 month after operation,and died of respiratory failure after medical treatment.Two cases did not recur after the second operation with chemotherapy.Postoperative fecal incontinence was found in 3 cases,constipation in 2 cases,and biofeedback therapy was performed in out-patient clinic.Two of the 3 cases of fecal incontinence have improved significantly after biofeedback therapy.One case of newborn SCT can not cooperate with no biofeedback because of its small age.Two cases of mild constipation were improved after biofeedback therapy prompted by rectal and anal manometry.Of 73 children with SCT,68 survived and 5 died,all of them were malignant,with a survival rate of 93.2%.2.Chi-square test showed that birth conditions(premature and full-term infants),tumor size(>10cm),intraoperative anal canal prolapse(yes or no),placement of VSD negative pressure drainage liquid dressing(yes or no)at the incision could affect the incidence of poor wound healing.There were significant differences among the groups(P values were 0.009,0.005,0.003 respectively);Altman clinical classification(type III,IV)could affect the incidence of poor wound healing.Postoperative incidence of anorectal dysfunction was significantly different between the two groups(P value was 0.001);intact capsule(whether or not),pathological type(benign,immature and malignant)could affect the recurrence rate after operation,and the difference between the two groups was statistically significant(P value was 0.003,0.009,respectively).Conclusion:1.Placing VSD in the incision after SCT can effectively reduce the incidence of poor wound healing,especially for preterm infants and children with large tumors,VSD should be placed to better manage the incision after SCT.Careful operation during operation and prevention of anal canal prolapse can significantly reduce the incidence of poor wound healing after operation.2.Anorectal manometry should be performed to understand the anorectal function after SCT of clinical type III and IV.If there are abnormalities,it should be treated as soon as possible.3.Reasonable choice of surgical methods,as far as possible complete dissection of the tumor,reduce the recurrence rate,pathologically diagnosed malignant SCT in addition to routine postoperative chemotherapy,should strengthen follow-up efforts.