脊髓部分栓塞之后的脊髓切除术会增加手术内出血吗?
Long Huang1, Qing-Lin Li2, Qing-Sheng Yu3
1Department of No. 1 Surgery, The First Hospital Affiliated to Anhui University of Traditional Chinese Medicine, Hefei 230031, Anhui Province, China. huanglong658@163.com.
World journal of gastrointestinal surgery
|March 11, 2024
概括
在为高缩症而进行切除术之前的部分栓塞可能会增加手术内出血. 预测模型可以识别有风险的患者,帮助肝硬化患者做出手术决策.
科学领域:
- 胃肠病学 胃肠病学
- 手术瘤学手术瘤学
- 干预性放射学 干预性放射学
背景情况:
- 部分囊栓塞 (PSE) 是治疗高囊症的囊切除术的替代方案.
- 在PSE后出现高缩症的复发可能需要进行缩切除术.
- 目前还没有证据表明,手术前的PSE是否可以减少脊髓切除术前的并发症.
研究的目的:
- 为了评估手术前的PSE的安全性和有效性,然后进行脊髓切除术.
- 评估患有肝硬化和高缩症的患者的并发症.
- 开发一个预测模型用于手术内出血 (IB).
主要方法:
- 对321名经过脊髓切除术 (2010-2021) 的肝硬化和脊髓增生症患者进行了回顾性分析.
- 使用倾向性得分匹配 (PSM) 进行PSE组 (n=40) 和非PSE组 (n=281) 的比较.
- 多变量分析和名录构造用于预测IB,经过ROC,Hosmer-Lemeshow和DCA的验证.
主要成果:
- 非PSE组的住院时间显著缩短,手术期间流血减少,PSM后手术时间缩短.
- 长,门静脉直径,静脉直径和PSE史独立预测IB.
- 诺米图表在预测IB方面表现出临床效用;整体存活率在各组之间相似.
结论:
- 手术前的PSE随后的脊髓切除术可能与手术内出血增加有关.
- 一个基于诺米图的预测模型有效地预测了手术内出血的发生.
- 进一步的研究可能会优化组合手术的患者选择.
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