Cui Yunpeng, Shi Xuedong, Mi Chuan, Wang Bing, Li Huaijin, Pan Yuanxing, Lin Yunfei
Department of Orthopaedics, Peking University First Hospital, No.7 Xishiku Street, Xicheng District, Beijing, 100032, China.
Department of Anesthesia, Peking University First Hospital, Beijing, China.
BMC Musculoskelet Disord. 2021 Oct 22;22(1):898. doi: 10.1186/s12891-021-04789-2.
Blood loss in posterior surgery patients with thoracolumbar metastasis posed a significant challenge to surgeons. This study aimed to explore the risk factors of blood loss in posterior surgery for patients with thoracolumbar metastasis.
One hundred forty-two patients were retrospectively reviewed. Their baseline characteristics were recorded. The Gross equation was used to calculate blood loss on a surgical day. Multivariate linear regression was used to analyze the risk factors.
Mean blood loss of 142 patients were 2055 ± 94 ml. Hypervascular primary tumor (kidney, thyroid and liver) (P = 0.017), wide or marginal excision (en-bloc: P = 0.001), metastasis at the lumbar spine (P = 0.033), and the presence of extraosseous tumor mass (P = 0.012) were independent risk factors of blood loss in the posterior surgery. Sub-analysis showed that wide or marginal excision (en-bloc: P < 0.001) and metastasis at lumbar spine (P = 0.007) were associated with blood loss for patients with non-hyper vascular primary tumors. Wide or marginal excision (piece-meal: P = 0.014) and the presence of an extraosseous tumor mass (P = 0.034) were associated with blood loss for patients with hypervascular primary tumors.
Hypervascular primary tumor (kidney, thyroid, and liver) was an independent risk factor of blood loss in the posterior surgery. The presence of extraosseous tumor mass and wide or marginal excision (piece-meal) were independent risk factors for patients with hypervascular primary tumors. Metastasis at the lumbar spine and wide or marginal excision (en-bloc) were independent risk factors for patients with non-hyper vascular primary tumors.
胸腰椎转移瘤后路手术患者的失血问题给外科医生带来了重大挑战。本研究旨在探讨胸腰椎转移瘤患者后路手术失血的危险因素。
回顾性分析142例患者。记录其基线特征。采用Gross公式计算手术当日失血量。采用多因素线性回归分析危险因素。
142例患者的平均失血量为2055±94ml。高血供原发肿瘤（肾、甲状腺和肝脏）（P = 0.017）、广泛或边缘性切除（整块切除：P = 0.001）、腰椎转移（P = 0.033）以及存在椎体外肿瘤块（P = 0.012）是后路手术失血的独立危险因素。亚组分析显示，对于非高血供原发肿瘤患者，广泛或边缘性切除（整块切除：P < 0.001）和腰椎转移（P = 0.007）与失血有关。对于高血供原发肿瘤患者，广泛或边缘性切除（分块切除：P = 0.014）和存在椎体外肿瘤块（P = 0.034）与失血有关。
高血供原发肿瘤（肾、甲状腺和肝脏）是后路手术失血的独立危险因素。对于高血供原发肿瘤患者，椎体外肿瘤块的存在以及广泛或边缘性切除（分块切除）是独立危险因素。对于非高血供原发肿瘤患者，腰椎转移和广泛或边缘性切除（整块切除）是独立危险因素。
