Technical Challenges and Utility of Anterior Exposure for Thoracic Spine Pathology
Technical Challenges and Utility of Anterior Exposure for Thoracic Spine Pathology
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DOI：
10.1016/j.athoracsur.2008.07.087
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发表时间：
2008-12-01
影响因子：
4.6
通讯作者：
Landreneau, Rodney J.
中科院分区：
文献类型：
--
作者：
Pettiford, Brian L.;Schuchert, Matthew J.;Landreneau, Rodney J.
胸外科医生经常被要求提供颈胸段、胸椎和近端腰椎的暴露。我们回顾了我们的手术经验和这些脊柱入路的围手术期结局。突出显示每个程序的相关技术和解剖考虑。分析了在一家机构接受11年前胸椎暴露的213例患者（116例女性，97例男性）。主要终点包括发病率、死亡率和围手术期结局。平均年龄为53.7岁。根据脊柱受累的位置和长度确定手术入路，包括颈胸（5例）、开胸（117例）和胸腹（91例）技术。恶性病因与最高围手术期死亡率相关（6.7%，p = 0.08）。感染手术与显著较高的并发症发生率（p = 0.041）和住院时间（p = 0.033）相关。矫正脊柱侧凸需要更长的手术时间（p < 0.001），并导致失血量增加（p = 0.16）。与开胸相比，胸腹联合入路手术时间（386 vs 316分钟）和住院时间（8 vs 6天）增加。脊柱病理学前路手术的增加需要胸外科医生更多的参与。胸外科医生需要熟悉脊柱前路暴露的解剖和技术特征，以优化手术效果。
Background Thoracic surgeons are frequently called upon to provide exposure to the anterior cervicothoracic, thoracic, and proximal lumbar spine. We reviewed our surgical experience and the perioperative outcomes of these spinal approaches. Relevant technical and anatomic considerations of each procedure are highlighted.Methods. A total of 213 patients (116 female, 97 male) undergoing anterior thoracic spinal exposures over an 11-year period at a single institution were analyzed. Primary endpoints include morbidity, mortality, and perioperative outcomes.Results. Mean age was 53.7 years. Surgical approaches were determined based on the location and length of spinal involvement, and included cervicothoracic (5), thoracotomy (117), and thoracoabdominal (91) techniques. Malignant etiologies were associated with the highest perioperative mortality (6.7%, p = 0.08). Procedures for infection were associated with a significantly higher complication rate (p = 0.041) and length of stay (p = 0.033). Correction of scoliosis required longer operative times (p < 0.001) and resulted in a trend toward higher blood loss (p = 0.16). Thoracoabdominal approaches were associated with increased operative times (386 vs 316 minutes) and length of stay (8 vs 6 days) compared with thoracotomy.Conclusions. The increased use of anterior approaches to spinal pathology necessitates greater involvement by thoracic surgeons. Familiarity with the anatomic and technical features of the anterior spinal exposure is required by thoracic surgeons to optimize surgical outcomes.