脊柱转移瘤分离术后发生胸腔积液的危险因素分析  

Analysis of risk factors of pleural effusion after spinal separation

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作  者:王柯懿 曲昊 王文 姚招浓[1] 周晓维 姚玉红[1] 李恒元[1] 林鹏[1] 李秀茅 严晓波[1] 柳萌[1] 黄鑫[1] 林秾[1] 叶招明[1] Wang Keyi;Qu Hao;Wang Wen;Yao Zhaonong;Zhou Xiaowei;Yao Yuhong;Li Hengyuan;Lin Peng;Li Xiumao;Yan Xiaobo;LiuMeng;Huang Xin;Lin Nong;Ye Zhaoming(Department of Orthopaedics,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区:[1]浙江大学医学院附属第二医院骨科,杭州310009

出  处:《中华骨科杂志》2024年第3期169-176,共8页Chinese Journal of Orthopaedics

基  金:浙江省科技计划项目(2022C01076)

摘  要:目的探讨脊柱转移瘤分离术后胸腔积液的危险因素。方法回顾性分析2014年1月至2022年1月于浙江大学医学院附属第二医院骨肿瘤科就诊的脊柱转移瘤患者427例,男252例、女175例,年龄(59±12)岁(范围15~87岁)。所有患者均接受脊柱转移瘤分离手术。基于术后1个月内的胸部CT,采用重建软件个性化测量胸腔积液量。将胸腔积液在0~500 ml定义为少量、500~1000 ml为中等量、1000 ml以上定义为大量。比较各组患者的基线资料和围手术期临床结果,将差异有统计学意义的指标纳入二分类logistic回归分析,确定脊柱转移瘤分离术后发生胸腔积液的独立危险因素。绘制受试者工作特性曲线,计算各独立危险因素的曲线下面积。结果所有患者均顺利完成手术。427例患者中大量胸腔积液35例、中等量胸腔积液42例、少量胸腔积液350例。大量胸腔积液组与少量及中等量胸腔积液组的肿瘤占位(χ^(2)=9.485,P=0.013)、术中失血量(Z=-2.503,P=0.011)、输血量(Z=-2.983,P=0.003)、术前总蛋白(Z=2.681,P=0.007)、术前白蛋白(Z=1.720,P=0.085)、术后血红蛋白(t=2.950,P=0.008)、术后总蛋白(Z=4.192,P<0.001)、术后白蛋白(t=2.268,P=0.032)的差异有统计学意义。将上述指标纳入logistic回归分析,结果显示术前白蛋白下降[OR=0.89,P=0.045]和转移瘤位于胸椎[OR=4.01,P=0.039]是导致脊柱转移瘤分离术后出现大量胸腔积液的独立危险因素。受试者工作特性曲线显示术前白蛋白、肿瘤占位及联合指标的曲线下面积及其95%CI分别为0.637(0.54,0.74)、0.421(0.36,0.48)、0.883(0.81,0.92),联合预测模型的预测价值为良。结论基于胸部CT可个性化定量测量胸腔积液体积。术前白蛋白下降和转移瘤位于胸椎是导致脊柱转移瘤分离术后出现大量胸腔积液的独立危险因素,二者联合预测具有更好的预测效能。Objective To investigate the risk factors of pleural effusion after spinal separation surgery for patients with spinal metastatic tumors.Methods A total of 427 patients with spinal metastatic tumors from January 2014 to January 2022 in the Second Affiliated Hospital of Zhejiang University School of Medicine were retrospectively analyzed.There were 252 males and 175 females,with an average age of 59±12 years(range,15-87 years).All patients underwent separation surgery.Based on the chest CT within 1 month after surgery,the volume of pleural effusion was measured individually by reconstruction software.Pleural effusion was defined as small volume(0-500 ml),moderate volume(500-1000 ml),and large volume(above 1000 ml).Baseline data and perioperative clinical outcomes were compared between the groups,and indicators with statistically significant differences were included in a binary logistic regression analysis to determine the independent risk factors for the development of pleural effusion after isolation of spinal metastatic cancer.Receiver operating characteristic(ROC)curves were conducted to calculate the area under the curve(AUC)for each independent risk factor.Results All patients successfully completed the operation.Among the 427 patients,there were 35 cases of large pleural effusion,42 cases of moderate pleural effusion,and 350 cases of small pleural effusion.There were significant differences in tumor size(χ^(2)=9.485,P=0.013),intraoperative blood loss(Z=-2.503,P=0.011),blood transfusion(Z=-2.983,P=0.003),preoperative total protein(Z=2.681,P=0.007),preoperative albumin(Z=1.720,P=0.085),postoperative hemoglobin(t=2.950,P=0.008),postoperative total protein(Z=4.192,P<0.001),and postoperative albumin(t=2.268,P=0.032)in the large pleural effusion group versus the small and moderate pleural effusion group.Logistic regression analysis showed that decreased preoperative albumin(OR=0.89,P=0.045)and metastases located in the thoracic spine(OR=4.01,P=0.039)were independent risk factors for the occurrence of large pleu

关 键 词:脊柱 肿瘤转移 外科手术 危险因素 

分 类 号:R738.1[医药卫生—肿瘤]

 

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