Surgical complications and prevention strategies for metastatic spinal tumors

doi:10.3877/cma.j.issn.2096-0263.2021.01.010

Abstract

Abstract:

With the improvement of comprehensive treatment for cancer, the average length of life expectancy is increased, and the incidence of metastatic spinal tumors is increasing. As a systemic disease, metastatic spinal tumor requires multidisciplinary treatment. Among which, surgical treatment is an important part, which can significantly relieve pain, restore spinal stability, reduce the possibility of spinal cord compression, and significantly improve the quality of life of patients. However, surgery increases the risk of perioperative complications due to the poor health of these patients. Fully understanding the causes of the possible complications and prevention strategies might help reduce the incidence of unnecessary complications. This review article focuses on the complications, potential risk factors and prevention strategies related to the surgery of metastatic spinal tumor, providing a certain reference value for the treatment of patients with spinal metastatic tumor.

Key words: Spinal tumor, Metastatic tumor, Surgical treatment, Complication, Risk factor, Prevention strategy

Hongzhi Hu, Wenbo Yang, Xiangtian Deng, Baichuan Wang, Zhicai Zhang, Jianxiang Liu, Qiang Wu, Zengwu Shao. Surgical complications and prevention strategies for metastatic spinal tumors[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2021, 07(01): 52-59.

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References 126

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手术并发症类型		预防策略
术中并发症
	脊髓和神经根损伤	术前：高剂量类固醇；术中：神经电生理监测；
	脊髓和神经根损伤	术后：维持脊髓灌注、类固醇激素；
	大量出血	术前：纠正凝血功能障碍、血管栓塞术、抗纤溶药物、低体温预防；术中：供瘤血管结扎、双极电凝止血、止血药品；
	大量出血	术后：密切监测血压和引流量的变化；
	硬脊膜损伤和脑脊液漏	术中：仔细分离肿瘤与硬膜的粘连、避免使用尖锐的器械、分离前彻底止血、直视下谨慎操作等；
术后并发症
	手术部位感染	术前：戒烟、纠正营养不良、控制血糖、预防使用抗生素；术中：遵守严格无菌操作原则、控制手术时间和术中出血量、严密缝合不留死腔；
	手术部位感染		术后：术后行放疗的间隔时间至少一周；
	静脉血栓栓塞	术后：抬高双侧下肢、物理预防（足底静脉泵、间歇充气加压装置、弹力袜等）、鼓励患者主动在床上做足踝部和关节的主动屈伸运动，争取早日下床活动、早期预防性应用抗凝剂；
	内固定失败	术中：合理设计和选择内固定装置和固定方式；术后：早期下床活动，密切随访；
	肿瘤复发	术后：对于富血供的原发肿瘤患者术后应密切随访。

手术并发症类型		预防策略
术中并发症
	脊髓和神经根损伤	术前：高剂量类固醇；术中：神经电生理监测；
	脊髓和神经根损伤	术后：维持脊髓灌注、类固醇激素；
	大量出血	术前：纠正凝血功能障碍、血管栓塞术、抗纤溶药物、低体温预防；术中：供瘤血管结扎、双极电凝止血、止血药品；
	大量出血	术后：密切监测血压和引流量的变化；
	硬脊膜损伤和脑脊液漏	术中：仔细分离肿瘤与硬膜的粘连、避免使用尖锐的器械、分离前彻底止血、直视下谨慎操作等；
术后并发症
	手术部位感染	术前：戒烟、纠正营养不良、控制血糖、预防使用抗生素；术中：遵守严格无菌操作原则、控制手术时间和术中出血量、严密缝合不留死腔；
	手术部位感染		术后：术后行放疗的间隔时间至少一周；
	静脉血栓栓塞	术后：抬高双侧下肢、物理预防（足底静脉泵、间歇充气加压装置、弹力袜等）、鼓励患者主动在床上做足踝部和关节的主动屈伸运动，争取早日下床活动、早期预防性应用抗凝剂；
	内固定失败	术中：合理设计和选择内固定装置和固定方式；术后：早期下床活动，密切随访；
	肿瘤复发	术后：对于富血供的原发肿瘤患者术后应密切随访。

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