Analysis Of Influencing Factors And Treatment Methods Of Subcutaneous Fluid After Craniotomy For Brain Tumors

Background:Subcutaneous hydrops is one of the common complications after craniotomy for brain tumors.Its causes include leakage of cerebrospinal fluid,inflammatory reaction and exudation of tissues,and so on.The subcutaneous hydrops has different levels of harm to the human body.In mild cases,it can be absorbed by itself and is almost harmless to the human body.In severe cases,it can affect the adhesion of skin flaps and bone flaps,delay incision healing,and cause incision infection,meningitis,brain abscess,etc.Therefore,it will prolong the hospitalization time of patients,affect the quality of life of patients,and even cause increased intracranial pressure,brain herniation,and life-threatening.Especially intractable subcutaneous hydrops can cause severe intracranial infections,whose curative effect is not good,which causes a serious burden on patients and their families.Exploring the influencing factors of subcutaneous hydrops after craniotomy for targeted prevention has become an important factor for the success of neurosurgical craniotomy.At the same time,for the subcutaneous effusion that has occurred,choosing the appropriate treatment method is another important problem faced by neurosurgeons.Objective:To find the incidence of subcutaneous hydrops after craniotomy and analyze its influencing factors.To provide a basis for effectively preventing subcutaneous hydrops after craniotomy.A retrospective analysis of the advantages and disadvantages of laser physiotherapy,puncture,and fluid extraction + compression bandaging two treatment methods,to provide a reference for the treatment of postoperative subcutaneous effusion.Methods:This research is divided into 2 parts.In the first part,we collected176 craniotomy patients from August 2019 to October 2020 in the Department of Oncological Neurosurgery of the First Hospital of Jilin University who met the criteria as the research object.The patients’ hospitalization information(age,gender),personal history(smoking and drinking),history(hypertension,diabetes,hypoproteinemia,etc.),co-infection,surgical site(superior and inferior),operation time,and the patient pathological type and other information.Analyze the influence of various factors on the generation of subcutaneous hydrops.Data description and analysis are carried out by SPSS25.0.Measurement data are expressed in mean((?)x)and standard deviation(SD),and count data are expressed in the number of cases and rate(%).The single-factor analysis was performed on the above influencing factors,and logistic multivariate regression analysis was performed on statistically significant indicators to explore independent risk factors for subcutaneous hydrops after craniotomy.P<0.05 indicates statistical significance.In the second part,28 patients with subcutaneous effusion from the above 176 patients were retrospectively analyzed.The 28 patients were divided into two groups,one group was treated with puncture and pressure dressing,and the other group was treated with laser therapy.The days of cure and the occurrence of adverse reactions(headache,wound nonhealing,cerebrospinal fluid leakage,etc.)in the two groups were statistically analyzed with SPSS25.0.P<0.05 indicated statistical significance.Results:1.The incidence of subcutaneous hydrops after craniotomy in our hospital was about 29.5%.Gender(P=0.007),co-infection(P=0.031),operation time(P=0.003),and ventricular drainage(P=0.001)are subcutaneous fluids after craniotomy influencing factors.Age,smoking,drinking,hypertension,diabetes,hypoproteinemia,surgical site,and pathological type of patients were not related to the occurrence of subcutaneous hydrops(P>0.05).Logistic regression analysis of the above influencing factors found that gender(P=0.010,OR=2.561,95%CI=1.256～5.211),and ventricular drainage(P=0.019,OR=4.099,P=1.261 ～ 13.321)are independent risk factors for subcutaneous hydrops after neurosurgical craniotomy.2.The average cure time was 2.03±1.580 days in the puncture extraction + pressure dressing group,and 4.69±1.690 days in the laser therapy group,P=0.01.There was a statistical difference between the two groups(P<0.05).The incidence of adverse reactions was 46.7% in the group of puncture effusion + pressure dressing and 7.7% in the group of laser therapy,P=0.038,and there was a statistical difference(P<0.05).Conclusion:1.In this study,the incidence of subcutaneous fluid after neurosurgery craniotomy was 29.5%.Males,postoperative infections,long operation time,bleeding volume >400,and those with ventricular drainage tubes are more likely to have subcutaneous fluid after craniotomy.Among them,gender and ventricular drainage are independent risk factors for subcutaneous effusion after craniotomy.Smoking,drinking,hypertension,diabetes,hypoproteinemia,surgical site,and patient pathological types have nothing to do with the occurrence of subcutaneous fluid.2.Compared with laser therapy,the treatment of puncture aspiration+ pressure dressing can cure subcutaneous effusion in a shorter time.However,at the same time,the incidence of adverse consequences such as headache wound nonhealing,cerebrospinal fluid leakage and other adverse consequences are higher in the treatment scheme of puncture and fluid extraction + pressure dressing.