Kumar Naresh, Zaw Aye Sandar, Khine Hnin Ei, Maharajan Karthikeyan, Wai Khin Lay, Tan Barry, Mastura Siti, Goy Raymond
Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore.
Investigational Medicine Unit, National University Health System, Singapore, Singapore.
Ann Surg Oncol. 2016 Jun;23(6):2079-86. doi: 10.1245/s10434-016-5092-8. Epub 2016 Jan 27.
Metastatic spine tumor surgery (MSTS) can be associated with significant blood loss. Previous studies did not provide comprehensive data on blood loss in MSTS. Thorough study elaborating the blood loss, transfusion requirement, and their influencing factors is required. This study aimed to investigate the estimated blood loss and transfusion requirements associated with various surgical approaches and surgically managed vertebral levels for spinal metastases from different primary tumors.
The study retrospectively evaluated 243 patients who underwent surgery for metastatic spine tumors at the authors' institution between 2005 and 2014. Estimated intraoperative blood loss and transfusion requirement were assessed for different primary tumors including lung, breast, prostate, gastrointestinal, renal, liver, thyroid, myeloma/lymphoma, and others; types of surgical procedure (cervical corpectomy ± stabilization, thoracolumbar posterior decompression ± instrumentation, thoracolumbar corpectomy, minimally invasive surgery); and levels of instrumentation and decompression. Multivariate linear regression was attempted to investigate the factors influencing blood loss and transfusion requirements.
The mean blood loss was 870 ± 720 ml, and the average blood transfusion was 1.5 ± 1.9 U. The mean blood loss was 1103 ml for patients who received blood transfusion and 597 ml for those who did not. Multivariate analysis showed that the significant factors influencing blood loss were primary tumor, type of surgery, and prolonged operative time. The influencing factors for blood transfusion were primary tumor, type of surgery, preoperative hemoglobin, and prolonged operative time.
Significant variations in blood loss and transfusion requirement were based on primary tumor of spinal metastases, surgical approaches, and operative time. These findings will help clinicians in preoperative planning to address the problem of blood loss during MSTS.
转移性脊柱肿瘤手术（MSTS）可能会导致大量失血。以往的研究并未提供关于MSTS失血情况的全面数据。需要进行深入研究以阐明失血情况、输血需求及其影响因素。本研究旨在调查与不同手术入路以及不同原发肿瘤导致的脊柱转移瘤手术治疗椎体节段相关的估计失血量和输血需求。
本研究回顾性评估了2005年至2014年间在作者所在机构接受转移性脊柱肿瘤手术的243例患者。评估了不同原发肿瘤（包括肺癌、乳腺癌、前列腺癌、胃肠道癌、肾癌、肝癌、甲状腺癌、骨髓瘤/淋巴瘤等）、手术类型（颈椎椎体次全切除±内固定、胸腰椎后路减压±内固定、胸腰椎椎体次全切除、微创手术）以及内固定和减压节段的估计术中失血量和输血需求。尝试通过多变量线性回归研究影响失血量和输血需求的因素。
平均失血量为870±720ml，平均输血量为1.5±1.9单位。接受输血的患者平均失血量为1103ml，未接受输血的患者平均失血量为597ml。多变量分析显示，影响失血量的显著因素为原发肿瘤、手术类型和手术时间延长。输血的影响因素为原发肿瘤、手术类型、术前血红蛋白水平和手术时间延长。
失血量和输血需求的显著差异取决于脊柱转移瘤的原发肿瘤、手术入路和手术时间。这些发现将有助于临床医生在术前规划中解决MSTS期间的失血问题。
