Liu Fu-Sheng, Wang Xiao-Bin, Tang Qi-Mu, Li Jing, Zhang Qian-Shi, Hu Jia-Rui, Wang Bing, Liu Fu-Bing
Second Xiangya Hospital of Central South University, Changsha, China.
Hunan University of Medicine General Hospital, Huaihua, China.
Eur Spine J. 2025 Aug;34(8):3601-3609. doi: 10.1007/s00586-025-09068-5. Epub 2025 Jun 18.
Thoracic or lumbar vertebrectomy is a complex spinal surgical procedure associated with considerable invasiveness and a high incidence of complications, including the infrequent chylous leakage. This study seeks to document the incidence of chylous leakage following thoracic or lumbar vertebrectomy and to investigate the risk factors associated with this complication, thereby offering insights into its prevention and management.
A retrospective analysis was performed with patients who underwent thoracic or lumbar vertebrectomy at our institution between July 2016 and March 2024. The patients who developed postoperative chylous leakage were incorporated into the chylous leakage group, and its incidence rate was determined. A subset of patients who underwent thoracic or lumbar vertebrectomy during the same surgical month as the chylous leakage cases while did not develop this complication were selected as control group. Comparative analyses of demographic variables, including gender, age, and surgical excised segments, were conducted between the two groups. Additionally, perioperative data, such as operation duration, blood loss, length of hospital stay, clinical outcomes, and radiological follow-up, were evaluated. Statistical analyses, including chi-square tests, Fisher's exact test, and t-tests, were employed to investigate the risk factors associated with chylous leakage following thoracic or lumbar vertebrectomy.
The study included a total of 545 patients who underwent thoracic or lumbar vertebrectomy, among whom 5 cases of chylous leakage were identified, corresponding to an incidence rate of 0.92%. The control group comprised 29 patients. No significant statistical differences were observed between the chylous leakage group and the control group regarding demographic characteristics. However, analysis of radiological and perioperative data indicated that the thickness of peri-lesion soft tissues was significantly greater in the chylous leakage group compared to the control group (16.58 ± 9.95 mm vs. 10.36 ± 5.19 mm, P = 0.04). Furthermore, the surgical excised segments were predominantly located between T10-L2, with a statistically significant difference compared to the control group (P = 0.039). Other parameters, including blood loss, transfusion volume, operation duration, surgical approach, and reconstruction methods, did not exhibit significant differences. One patient with chylous leakage developed a wound infection and received debridement with drainage. Other cases of chylous leakage were managed conservatively and resolved successfully.
Thoracic or lumbar vertebrectomy presents a risk of compromising the lymphatic system, potentially resulting in chylous leakage, especially in patients exhibiting over-thickened peri-lesion soft tissues or excised segments at the thoracolumbar region. Enhanced vigilance is warranted in these patients to mitigate the risk of postoperative chylous leakage.
胸椎或腰椎椎体切除术是一种复杂的脊柱外科手术，具有相当大的侵袭性且并发症发生率高，包括罕见的乳糜漏。本研究旨在记录胸椎或腰椎椎体切除术后乳糜漏的发生率，并调查与该并发症相关的危险因素，从而为其预防和管理提供见解。
对2016年7月至2024年3月在我院接受胸椎或腰椎椎体切除术的患者进行回顾性分析。将发生术后乳糜漏的患者纳入乳糜漏组，并确定其发生率。选择在与乳糜漏病例相同手术月份接受胸椎或腰椎椎体切除术但未发生该并发症的一部分患者作为对照组。对两组之间的人口统计学变量进行比较分析，包括性别、年龄和手术切除节段。此外，还评估了围手术期数据，如手术时间、失血量、住院时间、临床结果和影像学随访情况。采用卡方检验、Fisher精确检验和t检验等统计分析方法来研究胸椎或腰椎椎体切除术后与乳糜漏相关的危险因素。
本研究共纳入545例行胸椎或腰椎椎体切除术的患者，其中5例发生乳糜漏，发生率为0.92%。对照组包括29例患者。乳糜漏组和对照组在人口统计学特征方面未观察到显著的统计学差异。然而，影像学和围手术期数据分析表明，与对照组相比，乳糜漏组病变周围软组织厚度明显更大（16.58±9.95mm对10.36±5.19mm，P = 0.04）。此外，手术切除节段主要位于T10-L2之间，与对照组相比有统计学显著差异（P = 0.039）。其他参数，包括失血量、输血量、手术时间、手术入路和重建方法，均未显示出显著差异。1例乳糜漏患者发生伤口感染，接受了清创引流。其他乳糜漏病例经保守治疗成功治愈。
胸椎或腰椎椎体切除术存在损害淋巴系统的风险，可能导致乳糜漏，尤其是在病变周围软组织增厚或胸腰段切除节段的患者中。对于这些患者，有必要提高警惕以降低术后乳糜漏的风险。
