术前肿瘤滋养动脉栓堵对侵袭性椎体血管瘤椎体切除术的影响

Effect of preoperative feeding artery occlusion on invasive vertebral hemangioma resection

目的评估术前肿瘤滋养动脉栓堵对侵袭性椎体血管瘤椎体切除术的效果及安全性。方法回顾分析2010年3月—2017年3月采用病变后路椎体逐块切除植骨融合内固定术治疗的20例侵袭性椎体血管瘤患者临床资料,根据术前是否行肿瘤滋养动脉栓堵分为A组(11例,术前行肿瘤滋养动脉栓堵)和B组(9例,术前未行肿瘤滋养动脉栓堵)。两组患者性别、年龄、病变节段、病程等一般资料比较差异无统计学意义(P>0.05)。记录并比较两组手术时间、术中出血量、术后引流量、输血量、术后下床时间、住院时间及下肢深静脉血栓形成情况;采用疼痛视觉模拟评分(VAS)评价术后疼痛改善情况。结果 A组手术时间、术中出血量、输血量、术后下床时间均显著少于B组(P<0.05),两组术后引流量及住院时间比较差异无统计学意义(P>0.05)。5例患者(A组3例、B组2例)因术中胸膜粘连发生胸膜撕裂,均立即缝合后放置胸腔闭式引流管,于3～5 d拔管。两组患者均获随访,随访时间1～1.5年,平均1.35年。B组1例患者术后7 d因肺栓塞死亡;2例术后发生下肢深静脉血栓形成,行下腔静脉滤网及溶栓治疗,术后恢复良好。其余患者术后局部疼痛均明显减轻,术后1个月疼痛消失。两组术后3 d VAS评分均较术前显著改善(P<0.05),术前及术后3 d两组间VAS评分比较差异均无统计学意义(P>0.05)。术前3例(A组2例,B组1例)有神经症状者术后神经症状均较术前明显减轻。术后1年随访时两组植骨均达骨质愈合,随访期间无内固定物断裂、松动等情况发生。结论侵袭性椎体血管瘤椎体切除术前进行肿瘤滋养动脉栓堵可有效减少术中出血量、手术时间、围术期输血量及其他围术期并发症。

Objective To evaluate the effectiveness and safety of preoperative feeding artery occlusion on vertebral resection of invasive vertebral hemangioma. Methods The clinical data of 20 patients with invasive vertebral hemangioma who received posterior lumbar vertebral body resection, bone grafting, fusion and internal fixation between March 2010 and March 2017 were retrospectively analyzed. According to whether feeding artery occlusion was performed before operation, the patients were divided into group A(11 cases, tumor feeding artery occlusion before operation) and group B(9 cases, no tumor feeding artery occlusion before operation). There was no significant difference in gender, age,lesion segment, and disease duration between the two groups(P>0.05). The operation time, intraoperative blood loss,postoperative drainage volume, blood transfusion volume, and ambulant time after surgery, hospitalization time, and deep venous thrombosis of lower extremities were recorded and compared between the two groups. Pain improvement was evaluated by visual analogue scale(VAS) score. Results The operation time, intraoperative blood loss, blood transfusion volume, and ambulant time after surgery were significantly less in group A than those in group B(P<0.05). There was no significant difference in postoperative drainage volume and hospitalization time between the two groups(P>0.05). Five patients(3 in group A and 2 in group B) suffered from pleural tear due to intraoperative pleural adhesions. Closed thoracic drainage tubes were placed immediately after suture and extubated on 3-5 days. Both groups were followed up 1-1.5 years, with an average of 1.35 years. In group B, 1 patient died of pulmonary embolism at 7 days after operation;and2 patients developed deep venous thrombosis of lower extremity after operation, who were treated with inferior vena cava filter and thrombolytic therapy, and recovered well after operation. The local pain of the other patients was significantly relieved after operation, and the pain disappeared at 1 month after operation. The VAS scores of the two groups at 3 days after operation were significantly improved when compared with those before operation(P<0.05). There was no significant difference in VAS scores between the two groups before operation and at 3 days after operation(P>0.05). Three patients(2 in group A and 1 in group B) who had neurological symptoms were significantly relieved after surgery. Bone healing was achieved in both groups at 1 year after operation. No fracture or loosening of internal fixator occurred during follow-up. Conclusion Nutritional artery occlusion before vertebrectomy for invasive vertebral hemangioma can effectively reduce intraoperative blood loss, operation time, perioperative blood transfusion, and other perioperative complications.