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[脊柱肿瘤切除及前后路重建术后的术中及晚期并发症]

[Intraoperative and late complications after spinal tumour resection and dorsoventral reconstruction].

作者信息

Thomas A, Hollstein T, Zwingenberger S, Schaser K-D, Disch A C

机构信息

Universitätswirbelsäulenzentrum (UCSC), UniversitätsCentrum für Orthopädie und Unfallchirurgie (OUC), Universitätsklinikum Carl Gustav Carus Dresden, TU Dresden, Anstalt des öffentlichen Rechts des Freistaates Sachsen, Fetscherstraße 74, 01307, Dresden, Deutschland.

出版信息

Orthopade. 2020 Feb;49(2):157-168. doi: 10.1007/s00132-020-03883-y.

Abstract

BACKGROUND

Spinal tumors are a continuously growing pathology group among the spinal diseases. The often-difficult circumstances increase vulnerability to a wide range of intervention-related complications, which can occur at different times in the course of the disease and must be included in the consideration of the indication.

OBJECTIVES

The aim of the work is to present the wide spectrum of complications in the surgical treatment of spinal tumors, as well as their treatment and prophylaxis through optimal therapy management.

MATERIALS AND METHODS

The article summarizes the current literature.

RESULTS

The literature describes complication rates of 10-67% after metastatic surgery of the spinal column. The most common complications are infections and internal, especially pulmonary, complications. Other relevant complications include surgical positioning/surgical access/instrumentation/mechanical failure, and anesthesiological, neurological, vascular and oncological complications. The socio-economic costs for patients with complications compared to those for patients without complications are twice as high. A special risk situation exists with radical spinal tumor resections. Negative predictors are previous operations, previous irradiation and local recurrences.

CONCLUSIONS

An early, interdisciplinary concept can reduce complications significantly. Due to the planning intensity, surgical expertise and comprehensive structural requirements, treatment in an interdisciplinary tumour centre is necessary.

摘要

背景

脊柱肿瘤是脊柱疾病中一个不断增长的病理类型组。通常困难的情况增加了发生各种与干预相关并发症的易感性,这些并发症可在疾病过程中的不同时间出现,并且在考虑手术指征时必须予以考虑。

目的

这项工作的目的是介绍脊柱肿瘤手术治疗中广泛的并发症谱,以及通过优化治疗管理对其进行治疗和预防。

材料与方法

本文总结了当前的文献。

结果

文献报道脊柱转移瘤手术后的并发症发生率为10% - 67%。最常见的并发症是感染以及内科并发症,尤其是肺部并发症。其他相关并发症包括手术体位/手术入路/器械/机械故障,以及麻醉、神经、血管和肿瘤学并发症。有并发症的患者与无并发症的患者相比,社会经济成本高出两倍。脊柱肿瘤根治性切除存在特殊的风险情况。既往手术、既往放疗和局部复发是负面预测因素。

结论

早期的多学科概念可显著降低并发症。由于规划强度、手术专业知识和全面的结构要求,在多学科肿瘤中心进行治疗是必要的。

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