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[肾细胞癌脊柱转移的手术治疗:术中麻醉相关问题]

[The surgical treatment of renal cell carcinoma metastases to the vertebrae: intra-operative anesthesia related problems].

作者信息

Cappuccio M, Gasbarrini A, Bandello L, Focarazzo E, Bandiera S, De Iure F, Bròdano G Barbanti, Boriani S

机构信息

UO di Ortopedia e Traumatologia, Chirurgia del Rachide, Ospedale Maggiore C.A. Pizzardi, Bologna, Italia.

出版信息

Clin Ter. 2008 Jan-Feb;159(1):23-8.

Abstract

AIMS

Analysis of the intra-operative anesthesia related problems were compared during intra-lesional or extra-lesional surgeries for patients with metastatic renal cell carcinoma to the spine.

MATERIALS AND METHODS

We retrospectively collected and analyzed the hemodynamic data on 30 patients who had undergone surgical intervention. Twenty patients had an intra-lesional excision of the metastatic lesion in the vertebra, whereas for the rest, an en-bloc wide or marginal margin resection was carried out.

RESULTS

The surgical time for the en-bloc resections was much longer, and thus also the exposure to the anesthesia, but lesser variability within the data on blood pressure and pulse as compared with intra-lesional curettage. There was also more blood loss with the intra-lesional surgeries.

CONCLUSIONS

En-bloc resections of the vertebral tumors not only give better oncological local control, but also have less compromising effects on the patient, especially with respect to the intra-operative hemodynamics. In selected cases, en-bloc resections present a good option of treatment in vertebral metastases, and especially in highly vascular tumors such as the renal cell carcinoma metastases.

摘要

目的

比较转移性肾细胞癌脊柱转移患者在病损内或病损外手术期间与麻醉相关的术中问题。

材料与方法

我们回顾性收集并分析了30例接受手术干预患者的血流动力学数据。20例患者对椎骨转移性病变进行了病损内切除,其余患者则进行了整块广泛或边缘性切除。

结果

整块切除的手术时间长得多,因此麻醉暴露时间也更长,但与病损内刮除术相比,血压和脉搏数据的变异性较小。病损内手术的失血量也更多。

结论

椎骨肿瘤的整块切除不仅能更好地实现肿瘤局部控制,对患者的影响也较小,尤其是在术中血流动力学方面。在某些特定情况下,整块切除是脊柱转移瘤,尤其是肾细胞癌转移等血管丰富肿瘤的一种良好治疗选择。

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