Clausen Caroline, Dahl Benny, Frevert Susanne C, Hansen Lars V, Nielsen Michael Bachmann, Lönn Lars
Department of Radiology, Copenhagen University Hospital Rigshospitalet, 9 Blegdamsvej, 2100 Copenhagen, Denmark.
Department of Orthopaedic Surgery, Copenhagen University Hospital Rigshospitalet, 9 Blegdamsvej, 2100 Copenhagen, Denmark.
J Vasc Interv Radiol. 2015 Mar;26(3):402-12.e1. doi: 10.1016/j.jvir.2014.11.014. Epub 2015 Jan 28.
To assess whether preoperative transcatheter arterial embolization of spinal metastases reduces blood loss, the need for transfusion with allogeneic red blood cells (RBCs), and surgery time in the surgical treatment of patients with symptomatic metastatic spinal cord compression.
This single-blind, randomized (1:1), controlled, parallel-group, single-center trial was approved by the Danish National Committee on Biomedical Research Ethics and was conducted from May 2011-March 2013. Participants (N = 45) were scheduled for decompression and posterior thoracic/lumbar spinal instrumentation and randomly assigned to either preoperative embolization (n = 23) or a control group (n = 22). The primary outcome was intraoperative blood loss. Secondary outcomes were perioperative blood loss, allogeneic RBC transfusion, and surgery time. Analyses were performed by intention-to-treat.
The intention-to-treat analysis included 45 patients. Mean intraoperative blood loss did not differ significantly (P = .270) between the embolization group (618 mL [SD, 282 mL]) and the control group (735 mL [SD, 415 mL]). There was also no significant difference in allogeneic RBC transfusion (P = .243). Surgery time was significantly shorter in the embolization group (P = .031): median 90 minutes (range, 54-252 min) versus 124 minutes (range, 80-183 min). The subanalysis of hypervascular metastases revealed a significant (P = .041) reduction in blood loss in the embolization group: 645 mL (SD, 289 mL) versus 902 mL (SD, 416 mL).
Preoperative embolization in patients with symptomatic spinal metastasis independent of primary tumor diagnosis did not reduce intraoperative blood loss and allogeneic RBC transfusion significantly but did reduce the surgery time. A small reduction of intraoperative blood loss was shown in hypervascular metastases.
评估术前经导管动脉栓塞术治疗有症状的转移性脊髓压迫症患者，是否能减少手术中的失血量、异体红细胞（RBC）输注需求及手术时间。
这项单盲、随机（1:1）、对照、平行组、单中心试验经丹麦国家生物医学研究伦理委员会批准，于2011年5月至2013年3月进行。参与者（N = 45）计划接受减压及胸/腰段脊柱后路内固定手术，并随机分为术前栓塞组（n = 23）或对照组（n = 22）。主要结局是术中失血量。次要结局是围手术期失血量、异体RBC输注及手术时间。分析采用意向性分析。
意向性分析纳入45例患者。栓塞组（618 mL [标准差，282 mL]）与对照组（735 mL [标准差，415 mL]）的平均术中失血量无显著差异（P = 0.270）。异体RBC输注也无显著差异（P = 0.243）。栓塞组的手术时间显著缩短（P = 0.031）：中位数为90分钟（范围，54 - 252分钟），而对照组为124分钟（范围，80 - 183分钟）。对富血管转移瘤的亚组分析显示，栓塞组的失血量显著减少（P = 0.041）：645 mL（标准差，289 mL）对902 mL（标准差，416 mL）。
对于有症状的脊柱转移瘤患者，无论原发肿瘤诊断如何，术前栓塞术并未显著减少术中失血量和异体RBC输注，但确实缩短了手术时间。在富血管转移瘤中，术中失血量有小幅减少。
