Li Yanlei, Ge Meng, Tian Jinlong, Zhou Jinlei, Kang Yao, Xia Chen, Shao Haiyu, Wang Yongguang, Huang Yazeng, Zhao Tingxiao
Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, People's Republic of China.
Department of Orthopedics, Hospital of Traditional Chinese Medicine of Xiaoshan District, Hangzhou, Zhejiang, People's Republic of China.
Ther Clin Risk Manag. 2024 May 29;20:325-334. doi: 10.2147/TCRM.S462784. eCollection 2024.
Percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) has become one of the most popular minimally invasive surgeries today. However, the issue of hidden blood loss (HBL) in this surgery has received little attention. This study aims to examine the HBL in PE-TLIF surgery and the effect of tranexamic acid (TXA) on blood loss.
In our research, We conducted a retrospective analysis of 300 patients who underwent PE-TLIF from September 2019 to August 2023. They were divided into 2 groups based on whether they received intravenous TXA injection before surgery. The variables compared included: demographic data, pre-and postoperative hemoglobin (HB), hematocrit (HCT), platelets (PLT), red blood cells (RBC), total blood loss (TBL), visible blood loss (VBL), HBL, operation time, postoperative hospital stay, inflammatory markers, coagulation parameters, and adverse events.
Regarding demographic characteristics, besides the operation time, no significant differences were observed between the two groups. Compared with the control group, the TXA group showed a significant reduction trend in TBL, HBL, and VBL (P < 0.05). On the first day after surgery, there were significant differences in prothrombin (PT), activated partial thromboplastin time (APTT), and D-dimer (D-D) levels between the two groups. Similarly, HCT also found similar results on the third day after surgery. No adverse events occurred in either group.
Research has found that there is a significant amount of HBL in patients undergoing PE-TLIF. Intravenous injection of TXA can safely and effectively reduce perioperative HBL and VBL. Additionally, compared to the control group, the TXA group shows a significant reduction in operation time.
经皮内镜下经椎间孔腰椎椎间融合术（PE-TLIF）已成为当今最流行的微创手术之一。然而，该手术中隐性失血（HBL）的问题却很少受到关注。本研究旨在探讨PE-TLIF手术中的HBL以及氨甲环酸（TXA）对失血的影响。
在我们的研究中，我们对2019年9月至2023年8月接受PE-TLIF手术的300例患者进行了回顾性分析。根据术前是否接受静脉注射TXA，将他们分为2组。比较的变量包括：人口统计学数据、术前和术后血红蛋白（HB）、血细胞比容（HCT）、血小板（PLT）、红细胞（RBC）、总失血量（TBL）、显性失血量（VBL）、HBL、手术时间、术后住院时间、炎症标志物、凝血参数和不良事件。
在人口统计学特征方面，除手术时间外，两组之间未观察到显著差异。与对照组相比，TXA组的TBL、HBL和VBL有显著降低趋势（P < 0.05）。术后第一天，两组的凝血酶原（PT）、活化部分凝血活酶时间（APTT）和D-二聚体（D-D）水平存在显著差异。同样，术后第三天HCT也发现了类似结果。两组均未发生不良事件。
研究发现，接受PE-TLIF手术的患者存在大量HBL。静脉注射TXA可安全有效地减少围手术期HBL和VBL。此外，与对照组相比，TXA组的手术时间显著缩短。
