胸腰椎肿瘤整块切除的围术期并发症及危险因素

Perioperative complications and risk factors of en bloc resection for thoracic and lumbar spinal tumors

中文关键词:  脊柱肿瘤  胸腰椎  整块切除  前柱重建  并发症

英文关键词:Spinal tumor  Thoracic and lumbar spine  En bloc resection  Anterior column reconstruction  Complication

中文摘要:

  【摘要】 目的：探讨胸腰椎肿瘤整块切除术后手术围术期并发症的发生情况及危险因素。方法：回顾性分析以胸腰椎肿瘤就诊于我科并行整块切除和前柱重建手术的患者资料。2016年5月~2022年10月，有90例连续患者在我科根据Weinstein-Boriani-Biagini外科分期系统进行整块切除，使用3D打印人工椎体进行前柱重建。收集这些患者的人口学、肿瘤学和手术学数据，依据并发症对康复过程的影响将术中及术后3个月内发生的并发症分为严重并发症和轻微并发症（严重并发症指任何会显著改变患者的预期恢复过程的并发症，余为轻微并发症）；依据既往手术史将所有患者分为初术组（n=67）和翻修组（n=23）。比较各组患者在年龄、性别、病理类型、肿瘤累及节段、手术时间、术中失血和围术期并发症等上的区别，并进行回归分析，探索严重和轻微并发症的危险因素。结果：所有患者均按计划完成了整块切除手术，其中全椎切除77例，矢状切除12例，椎体切除1例；平均手术时间553.4min（210~1208min），术中失血1534.1mL（260~5500mL）。共65例（72.2%）患者发生129例次围术期并发症，其中21例（23.3%）患者发生29例严重并发症，2例（2.2%）患者死亡。翻修组比初术组的多节段受累更多（P=0.000），严重并发症发生率更高（P=0.038）。在单变量回归分析中，联合入路（OR=14.778，P=0.001）、总失血量（OR=1.004，P=0.004）、分期手术（OR=5.250，P=0.008）、既往手术史（OR=2.946，P=0.043）、肿瘤累及节段数（OR=1.607，P=0.023）和腰椎肿瘤（OR=3.509，P=0.015）是严重并发症发生的危险因素，其中联合入路（OR=6.375，P=0.036）是严重并发症的独立危险因素。结论：对胸腰椎肿瘤进行整块切除和前柱重建有很高的并发症风险，尤其是需要联合入路时。

英文摘要:

  【Abstract】 Objectives: To investigate the incidence and risk factors of perioperative complications after en bloc resection for thoracic and lumbar spinal tumors. Methods: The data of patients with thoracic and lumbar spinal tumors treated in our department with en bloc resection and anterior column reconstruction were retrospectively analyzed. Between May 2016 and October 2022, 90 consecutive patients underwent en bloc resection on the basis of Weinstein-Boriani-Biagini surgical staging system, and anterior reconstruction was performed using 3D-printed artificial vertebral bodies. The demographic, oncological, and operative data of the patients were collected prospectively, and the intraoperative and postoperative complications occurring within three months were categorized into major and minor complications according to their impacts on the recovery process(Major complications were considered as any complication that appeared to substantially alter an otherwise full and expected course of recovery, and other complications were regarded as minor). All the patients were divided into the primary group(n=67) and revision group(n=23) based on their previous surgical history. Differences between the two groups in terms of age, gender, pathological type, tumor-involved segments, operative time, intraoperative blood loss, and perioperative complications were compared. The predictive factors for major and minor complications were explored. Results: En bloc resection was achieved in all the patients, including total en bloc spondylectomy in 77 cases, sagittal resection in 12 cases, and vertebrectomy in one case. The mean operative time was 553.4min(210-1208min), and the mean intraoperative blood loss was 1534.1mL(260-5500mL). A total of 129 complications were observed in 65(72.2%) patients, including 29 major complications in 21(23.3%) patients. Two patients(2.2%) died as a result of complications. The revision group was more than primary group in tumor-involved segments(P=0.000) and incidence rate of major complications(P=0.038). In univariate regression analysis, the combined approach[odds ratio(OR)=14.778, P=0.001], total blood loss(OR=1.004, P=0.004), staged surgery(OR=5.250, P=0.008), previous surgical history(OR=2.946, P=0.043), number of tumor-involved vertebrae(OR=1.607, P=0.023) and lumbar tumor(OR=3.509, P=0.015) were statistically significant risk factors for major complication occurrence, while the combined approach(OR=6.375, P=0.036) was the independent risk factor. Conclusions: En bloc resection and anterior column reconstruction is associated with high risks of complications, especially when a combined approach is needed.