微创小切口减压手术治疗胸腰椎转移瘤的安全性和有效性

Safety and efficacy of minimally invasive small incision decompression surgery for the treatment of thoracolumbar metastatic cancer

中文关键词:  脊柱转移瘤  小切口  微创脊柱手术  失血  输血

英文关键词:Spinal metastatic cancer  Small incision  Minimally invasive spinal surgery  Blood loss  Blood transfusion

中文摘要:

  【摘要】 目的：评估胸腰椎转移瘤患者接受微创小切口减压手术的安全性和有效性。方法：回顾性分析2017年6月～2024年3月因脊柱转移瘤在我科行后路减压手术治疗的71例患者临床资料，男55例，女16例，年龄63.9±1.2岁；其中24例患者接受后路微创小切口减压手术，47例接受传统后路减压手术。用独立样本t检验和卡方检验来评估两组患者在年龄、性别、原发肿瘤病理类型与血供、手术部位以及术前是否栓塞等基线数据上的差异，以及总失血量、手术时间，手术并发症，手术日异体血输入量，术后引流量和引流管留置时间，术后住院时间之间的差异。结果：两组患者基线数据无明显差异（P<0.001）。微创小切口组患者手术日失血量显著低于传统手术组（P=0.003）。微创小切口组患者手术日输血（P=0.011）、术后总引流量（P=0.000）、引流管留置时间（P=0.000）以及术后住院时间P=0.000均较传统手术组显著降低。小切口微创组患者术后第1天ALB下降程度较传统手术组显著改善（P=0.040）。两组患者在硬膜损伤发生率以及术后疼痛，功能改善方面无显著差异。结论：微创小切口减压手术能有效减少胸腰椎转移瘤患者手术失血及异体血输注，缩短患者术后住院时间，手术并发症及术后功能改善与传统手术相同。

英文摘要:

  【Abstract】 Objectives: This study aims to evaluate the safety and efficacy of minimally invasive small incision decompression surgery for patients with thoracolumbar metastatic cancer. Methods: A retrospective analysis was conducted on 71 cases of spinal metastases who underwent posterior decompression surgery in our department from June 2017 to March 2024. There were 55 males and 16 females with an average age of 63.9±1.2 years. Among them, 24 patients underwent posterior minimally invasive small incision decompression surgery, and 47 patients underwent routine posterior decompression surgery. Independent sample t-test and chi square test were used to evaluate the differences between the two groups of patients in baseline data such as age, gender, primary tumor pathological type and blood supply, surgical site, and preoperative embolism, as well as the differences in total blood loss, surgical time, surgical complications, postoperative allogeneic blood transfusion volume, postoperative drainage volume and drainage tube retention time, and postoperative hospitalization time. Results: There was no significant difference in baseline data between the two groups of patients(P<0.001). The postoperative blood loss in the minimally invasive small incision group was significantly lower than that in the conventional surgery group(P=0.003). The postoperative blood transfusion(P=0.011), total drainage volume(P=0.000), drainage tube retention time(P=0.000), and postoperative hospital stay(P=0.000) were significantly reduced in the minimally invasive small incision group compared to the conventional surgery group. The decrease in ALB on the first day after surgery in the minimally invasive group was significantly improved compared to the conventional surgery group(P=0.040). There was no significant difference in the incidence of dural injury, postoperative pain, and functional improvement between the two groups of patients. Conclusions: Minimally invasive small incision decompression surgery can effectively reduce surgical blood loss and allogeneic blood transfusion in patients, shorten postoperative hospital stay, and improve surgical complications and postoperative function similar to conventional surgery.