脊柱转移瘤术中出血量影响因素分析

Analysis of factors affecting intraoperative blood loss in surgery of spinal metastatic tumor

中文关键词:  脊柱转移瘤  术中出血量  影响因素

英文关键词:Spinal metastases  Intraoperative blood loss  Influencing factors

中文摘要:

  【摘要】 目的：探讨脊柱转移瘤手术术中出血量的影响因素，为临床制定个性化手术方案及术中出血控制措施提供科学依据。方法：回顾性分析2019年1月~2024年9月首都医科大学附属北京世纪坛医院脊柱外科收治的223例脊柱转移瘤手术患者的临床资料，手术方式包括椎体成形术，肿瘤切除或部分切除、椎体重建内固定术以及姑息性手术。收集患者的一般资料[年龄、性别、体质指数（body mass index，BMI）等]、肿瘤特征（原发肿瘤类型、椎体转移部位及受累区域、椎体外转移灶数量等）、手术相关因素（手术方式、是否机器人辅助、手术时长等）及术中出血量。将上述指标逐个进行单因素回归分析，将具有统计学意义的指标进行多因素回归分析，明确各因素对术中出血量的影响。结果：223例患者的术中出血量为300mL（10，1000mL），其中胸椎和腰椎的转移比例较高，且富血供肿瘤出血量较多；肿瘤切除或部分切除、椎体重建内固定术组出血量多于其他两组。单因素分析显示，BMI（P<0.001）、原发肿瘤类型（P<0.001）、椎体转移部位（P<0.001）、椎体受累区域（P<0.001）、椎体外转移灶数量（P=0.03）、手术方式（P<0.001）、机器人辅助（P<0.001）及手术时长（P<0.001）均与术中出血量相关。多因素分析结果显示，BMI（P<0.001）、原发肿瘤类型（P=0.02）、椎体转移部位（P=0.02）及受累区域（P=0.004）、手术方式（P=0.04）及手术时长（P<0.001）是术中出血量的独立影响因素。结论：脊柱转移瘤术中出血量受BMI、原发肿瘤类型、椎体转移部位及受累区域、手术方式及手术时长影响，术前应充分评估、合理选择手术方式及提升手术技巧以缩短手术时间。

英文摘要:

  【Abstract】 Objectives: To investigate the factors influencing intraoperative blood loss in spinal metastatic tumor surgery and provide scientific evidence for personalized surgical planning and blood loss control measures in clinical practice. Methods: We retrospectively analyzed the clinical data of 223 patients with spinal metastatic tumors treated at the Spinal Surgery Department of Beijing Shijitan Hospital Affiliated to Capital Medical University from January 2019 to September 2024. The surgical methods included vertebroplasty, tumor resection or partial resection, vertebral body reconstruction and internal fixation, and palliative surgery. Data collected included patient demographics(age, sex, BMI, etc.), tumor characteristics(primary tumor type, vertebral metastasis location and involvement area, number of extraspinal metastases, etc.), surgical factors(surgical approach, robotic assistance, operative time, etc.), and intraoperative blood loss. Univariate regression analysis was conducted on each of the above indicators, and multivariate regression analysis was performed on the indicators with statistical significance to identify the influence of each factor on intraoperative blood loss. Results: The intraoperative blood loss was 300mL(10, 1000mL). Among the 223 patients, the proportion of metastasis in the thoracic and lumbar vertebrae was relatively high, and the blood loss was relatively significant in hypervascular tumors. The amount of blood loss in the tumor resection or partial resection and vertebral body reconstruction and internal fixation groups was greater than that in the other two groups. Univariate analysis revealed that BMI(P<0.001), primary tumor type(P<0.001), vertebral metastasis location(P<0.001), vertebral involvement area(P<0.001), number of extraspinal metastases(P=0.03), surgical approach(P<0.001), robotic assistance(P<0.001), and operative time(P<0.001) were associated with intraoperative blood loss. Multivariate analysis identified BMI(P<0.001), primary tumor type(P=0.02), vertebral metastasis location(P=0.02) and involvement area(P=0.004), surgical approach(P=0.04), and operative time(P<0.001) as the independent predictors of intraoperative blood loss. Conclusions: Intraoperative blood loss in spinal metastatic tumor surgery is influenced by multiple factors, including BMI, primary tumor type, vertebral metastasis location and involvement area, surgical approach, and operative time. Sufficient preoperative evaluation shall be carried out, appropriate surgical approach shall be selected, and surgical techniques shall be improved to shorten operative time.