脊柱转移瘤手术术前栓塞的最佳时间安排。

Optimal schedule of preoperative embolization for spinal metastasis surgery.

机构信息

Departments of *Orthopaedic Surgery and Musculoskeletal Oncology and †Radiology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.

出版信息

Spine (Phila Pa 1976). 2013 Oct 15;38(22):1964-9. doi: 10.1097/BRS.0b013e3182a46576.

DOI:10.1097/BRS.0b013e3182a46576

PMID:23917645

Abstract

STUDY DESIGN

A retrospective study.

OBJECTIVE

To investigate the relationship between intraoperative blood loss during spinal metastasis surgery and the surgical delay after preoperative embolization.

SUMMARY OF BACKGROUND DATA

Delaying surgery after embolization is thought to diminish its effectiveness because of revascularization, but there has been no scientific study that supports this hypothesis.

METHODS

We reviewed data from 66 consecutive posterior palliative decompression surgical procedures for spinal metastasis from thyroid and renal cell carcinoma (39 thyroid and 27 renal) in 58 patients between 2004 and 2012. All patients underwent preoperative angiography. The timing of preoperative embolization was determined on the basis of the operating room and interventional radiologist schedules. Excluding one case who did not receive embolization due to lack of hypervascularity, we analyzed 65 cases to compare intraoperative blood loss according to the completeness of embolization and the time lapse between embolization and surgery.

RESULTS

Surgical procedures were performed on the same day of embolization in 21 cases (same day-group), and on the next day after embolization in 39 cases (next-day group). Five surgical procedures were performed 2 days later. The intraoperative blood loss was significantly lesser with complete embolization than with partial embolization (mean ± standard deviation: 809 ± 835 vs. 1210 ± 904 mL, P = 0.03). Among those with complete embolization, the intraoperative blood loss as well as the perioperative transfusion requirement was significantly lesser in the same-day group than in the next-day group (mean ± standard deviation: blood loss: 433 ± 376 vs. 1012 ± 974 mL, P = 0.01; transfusion requirement: 1.5 ± 1.7 vs. 4.2 ± 4.1 units, P = 0.04).

CONCLUSION

Preoperative embolization showed greater effectiveness in reducing intraoperative blood loss when surgery for spinal metastasis was performed on the same day than when surgery was delayed. Surgery should be performed on the same day of embolization if possible.

LEVEL OF EVIDENCE

摘要

研究设计

回顾性研究。

目的

探讨脊柱转移瘤手术中术中失血量与术前栓塞后手术延迟的关系。

背景资料概要

栓塞后延迟手术被认为会降低其效果，因为会发生再血管化，但目前还没有科学研究支持这一假设。

方法

我们回顾了 2004 年至 2012 年间 58 例甲状腺和肾细胞癌（甲状腺 39 例，肾 27 例）患者 66 例后路姑息性减压手术的资料。所有患者均行术前血管造影。根据手术室和介入放射科医生的安排确定术前栓塞的时机。排除因血管丰富度不足而未行栓塞的 1 例患者，我们分析了 65 例患者的资料，根据栓塞的完全性和栓塞与手术之间的时间间隔比较术中失血量。

结果

21 例患者（同日组）在栓塞当日进行手术，39 例患者（次日组）在栓塞次日进行手术。5 例手术推迟 2 天进行。完全栓塞的术中出血量明显少于部分栓塞（平均±标准差：809±835 vs. 1210±904 ml，P=0.03）。在完全栓塞的患者中，同日组的术中出血量和围手术期输血需求明显少于次日组（平均±标准差：出血量：433±376 vs. 1012±974 ml，P=0.01；输血需求：1.5±1.7 vs. 4.2±4.1 单位，P=0.04）。