目的:腰椎前路椎间融合术(ALIF)是许多腰椎退行性病变的有效手术方式,但罕见且不常报告的并发症是术后淋巴囊肿。本研究的目标是回顾在高容量机构接受ALIF的大量连续系列患者,估计ALIF后淋巴囊肿的发生率,并调查ALIF后发生淋巴囊肿患者的结局。
方法:完成了对电子病历的回顾性审查,确定2012年至2019年至少接受单水平ALIF的所有患者(≥18岁).术后脊柱和腹部图像,以及放射科医生的报告,被审查提到淋巴囊肿。收集并报告临床数据。
结果:共有1322名患者接受了最低1级ALIF。在这些病人中,937(70.9%)有术后腹部或腰椎图像,结果淋巴囊肿发生率为2.1%(20/937例).平均±SD年龄为67±10.9岁,男女比例为1:1。有淋巴囊肿的患者明显比没有淋巴囊肿的患者年龄大(66.9岁vs58.9岁,p=0.006)。此外,淋巴囊肿患者的平均融合水平较高(2.5vs1.8,p<0.001),并且在L2-4时更可能发生ALIF(95.0%vs66.4%,p=0.007)比没有淋巴囊肿的患者。在随后的多变量分析中,年龄(OR1.07,95%CI1.01-1.12,p=0.013),BMI(OR1.10,95%CI1.01-1.18,p=0.021),和融合水平数(OR1.82,95%CI1.05-3.14,p=0.032)是术后淋巴囊肿发展的独立预测指标。有症状的淋巴囊肿患者通过介入放射学(IR)引流和/或硬化疗法成功治疗,并获得了放射学分辨率。平均住院时间为9.1±5.2天。10名患者(50%)术后出院到康复中心:8名患者(40%)出院回家,1(5%)到熟练的护理机构,和1(5%)长期急性护理机构。
结论:在ALIF之后,2.1%的患者被诊断为影像学检查确定的术后淋巴囊肿,并有危险因素,如年龄增加,BMI,和融合的级别数。大多数患者在术后1个月内出现,他们的临床表现包括腹痛,腹胀,和/或伤口并发症。值得注意的是,25%的确定的淋巴囊肿是偶然发现的。有症状的淋巴囊肿患者通过IR引流和/或硬化疗法成功治疗,并获得了影像学分辨率。
Anterior lumbar interbody fusion (ALIF) is an effective surgical modality for many lumbar degenerative pathologies, but a rare and infrequently reported complication is postoperative lymphocele. The goals of the present study were to
review a large consecutive series of patients who underwent
ALIF at a high-volume institution, estimate the rate of lymphocele occurrence after ALIF, and investigate the outcomes of patients who developed lymphocele after
ALIF.
A retrospective
review of the electronic medical record was completed, identifying all patients (≥ 18 years old) who underwent at a minimum a single-level
ALIF from 2012 through 2019. Postoperative spinal and abdominal images, as well as radiologist reports, were reviewed for mention of lymphocele. Clinical data were collected and reported.
A total of 1322 patients underwent a minimum 1-level
ALIF. Of these patients, 937 (70.9%) had either postoperative abdominal or lumbar spine images, and the resulting lymphocele incidence was 2.1% (20/937 patients). The mean ± SD age was 67 ± 10.9 years, and the male/female ratio was 1:1. Patients with lymphocele were significantly older than those without lymphocele (66.9 vs 58.9 years, p = 0.006). In addition, patients with lymphocele had a greater number of mean levels fused (2.5 vs 1.8, p < 0.001) and were more likely to have undergone ALIF at L2-4 (95.0% vs 66.4%, p = 0.007) than patients without lymphocele. On subsequent multivariate analysis, age (OR 1.07, 95% CI 1.01-1.12, p = 0.013), BMI (OR 1.10, 95% CI 1.01-1.18, p = 0.021), and number of levels fused (OR 1.82, 95% CI 1.05-3.14, p = 0.032) were independent prognosticators of postoperative lymphocele development. Patients with symptomatic lymphocele were successfully treated with either interventional radiology (IR) drainage and/or sclerosis therapy and achieved radiographic resolution. The mean ± SD length of hospital stay was 9.1 ± 5.2 days. Ten patients (50%) were postoperatively discharged to a rehabilitation center: 8 patients (40%) were discharged to home, 1 (5%) to a skilled nursing facility, and 1 (5%) to a long-term acute care facility.
After ALIF, 2.1% of patients were diagnosed with radiographically identified postoperative lymphocele and had risk factors such as increased age, BMI, and number of levels fused. Most patients presented within 1 month postoperatively, and their clinical presentations included abdominal pain, abdominal distension, and/or wound complications. Of note, 25% of identified lymphoceles were discovered incidentally. Patients with symptomatic lymphocele were successfully treated with either IR drainage and/or sclerosis therapy and achieved radiographic resolution.