Tan Barry Wei Loong, Zaw Aye Sandar, Rajendran Prapul Chander, Ruiz John Nathaniel, Kumar Naresh, Anil Gopinathan
Department of Orthopaedic Surgery, National University Hospital, Singapore 119074, Singapore.
Department of Diagnostic Imaging, National University Hospital, Singapore 119074, Singapore.
J Clin Neurosci. 2017 Sep;43:108-114. doi: 10.1016/j.jocn.2017.05.021. Epub 2017 Jun 16.
We conducted a retrospective review of 221 patients, who underwent spinal oncologic surgery at a tertiary university hospital between 2005 and 2014; in order to identify and validate factors that influence the impact of preoperative embolization of spinal tumours on outcome measures of blood loss and transfusion requirements in spinal oncologic surgery. We also focused on primary tumour type and type of spinal surgery performed. Patients' electronic and physical records were reviewed to provide demographic data, tumour characteristics, embolization techniques and surgical procedure details. These data were analysed against recorded outcome measures of blood loss (absolute volume and haemoglobin reduction) and transfusion requirements. Forty eight patients who received preoperative embolization were compared against 173 patients who did not. There was a tendency towards reduced blood loss and transfusion requirements in embolized spinal metastases from HCC and thyroid; as well as primary spine tumours, though the differences were not significant. Total embolization of arterial supply to spinal tumours resulted in significantly less blood loss as compared to partial or subtotal embolization. In addition, median blood loss was lower in patients receiving a more proximal embolization and in patients who underwent surgery between 13 and 24h post-embolization despite the insignificant difference. To conclude, preoperative spinal tumour embolization is likely to be effective in reducing blood loss if a total embolization is performed 13-24h prior to the surgery. Similarly, the impact of embolization is likely to be more profound in metastases from HCC, thyroid and primary spine tumours.
我们对221例患者进行了回顾性研究，这些患者于2005年至2014年间在一家三级大学医院接受了脊柱肿瘤手术；目的是识别和验证影响脊柱肿瘤术前栓塞对脊柱肿瘤手术中失血量和输血需求结果指标影响的因素。我们还关注了原发性肿瘤类型和所进行的脊柱手术类型。对患者的电子和纸质记录进行了审查，以提供人口统计学数据、肿瘤特征、栓塞技术和手术过程细节。将这些数据与记录的失血量（绝对量和血红蛋白降低量）和输血需求结果指标进行分析。将48例接受术前栓塞的患者与173例未接受术前栓塞的患者进行比较。肝癌和甲状腺的栓塞性脊柱转移瘤以及原发性脊柱肿瘤有减少失血量和输血需求的趋势，尽管差异不显著。与部分或次全栓塞相比，对脊柱肿瘤的动脉供应进行完全栓塞导致的失血量显著减少。此外，接受更近端栓塞的患者以及在栓塞后13至24小时内接受手术的患者，其失血量中位数较低，尽管差异不显著。总之，如果在手术前13至24小时进行完全栓塞，术前脊柱肿瘤栓塞可能有效减少失血量。同样，栓塞对肝癌、甲状腺和原发性脊柱肿瘤转移瘤的影响可能更为显著。
