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在高血管脊髓转移中术前栓塞后的外科结果:一项对191名患者的倾向性得分研究

Robertus J B Pierik^1,2, Jantijn J G J Amelink^1,2, Olivier Q Groot²

¹Department of Orthopedic Surgery, Massachusetts General Hospital-Harvard Medical School, Boston, MA.

|October 25, 2024

概括

术前栓塞 (PE) 并没有减少对小于9厘米3的脊髓瘤的血液流失或输血. 研究结果表明,PE的可用性不应延迟对高血管脊髓转移的紧急手术.

科学领域:

神经外科神经外科
在瘤学瘤学.
干预性放射学干预性放射学

背景情况:

手术前栓塞 (PE) 旨在减少在高血管脊髓瘤中手术性失血.
以前对脊髓转移的PE研究存在局限性,包括小队列和缺乏混因子纠正.
关于PE在减少这些瘤的血液流失方面的有效性,存在相互矛盾的结果.

研究的目的:

评估手术前栓塞 (PE) 对手术内输血和从高血管组织学转移脊髓转移的患者的二次结果的影响.
具体评估PE对估计的血液损失 (EBL) 和血红蛋白质量损失的影响.
分析PE对其他结果的影响,例如输血率和存活率.

主要方法:

一个回顾性,倾向性得分匹配,病例对照研究在两个学术高等保健中心进行.
接受PE的46名患者与没有接受PE的46名对照患者进行了匹配.
使用回归模型分析血液损失 (EBL,血红蛋白质量损失) 和输血数据.

主要成果:

在PE和非PE组之间没有观察到估计的血液损失 (EBL) 或血红蛋白质量损失的显著差异.
在二次结果中没有发现显著差异,除了PE组的1年生存率更高 (65%与43%相比).
多重回归分析证实,PE与减少手术期间的血液损失,血红蛋白质量损失或术后输血无关.

结论:

对于瘤体积小于9厘米的高血管组织学脊柱转移,手术前栓塞 (PE) 不能显著减少血液损失或输血需求.
这些发现表明,PE的可用性不应该阻碍对高血管瘤的紧急脊柱手术.
未来使用PE用于脊髓转移可能取决于精确的手术前检测超出组织学类型的高血管性.

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