Objectives:To investigate the factors influencing intraoperative blood loss in spinal metastatic tu-mor surgery and provide scientific evidence for personalized surgical planning and blood loss control measures in clinical practice.Methods:We retrospectively analyzed the clinical data of 223 patients with spinal metastatic tumors treated at the Spinal Surgery Department of Beijing Shijitan Hospital Affiliated to Capital Medical University from January 2019 to September 2024.The surgical methods included vertebroplasty,tumor resection or partial resection,vertebral body reconstruction and internal fixation,and palliative surgery.Data collected included patient demographics(age,sex,BMI,etc.),tumor characteristics(primary tumor type,vertebral metastasis location and involvement area,number of extraspinal metastases,etc.),surgical factors(surgical ap-proach,robotic assistance,operative time,etc.),and intraoperative blood loss.Univariate regression analysis was conducted on each of the above indicators,and multivariate regression analysis was performed on the in-dicators with statistical significance to identify the influence of each factor on intraoperative blood loss.Re-sults:The intraoperative blood loss was 300mL(10,1000mL).Among the 223 patients,the proportion of metastasis in the thoracic and lumbar vertebrae was relatively high,and the blood loss was relatively signifi-cant in hypervascular tumors.The amount of blood loss in the tumor resection or partial resection and verte-bral body reconstruction and internal fixation groups was greater than that in the other two groups.Univariate analysis revealed that BMI(P＜0.001),primary tumor type(P＜0.001),vertebral metastasis location(P＜0.001),verte-bral involvement area(P＜0.001),number of extraspinal metastases(P=0.03),surgical approach(P＜0.001),robotic assistance(P＜0.001),and operative time(P＜0.001)were associated with intraoperative blood loss.Multivariate analysis identified BMI(P＜0.001),primary tumor type(P=0.02),vertebral metastasis location(P=0.02)and involve-ment area(P=0.004),surgical approach(P=0.04),and operative time(P＜0.001)as the independent predictors of intraoperative blood loss.Conclusions:Intraoperative blood loss in spinal metastatic tumor surgery is influ-enced by multiple factors,including BMI,primary tumor type,vertebral metastasis location and involvement area,surgical approach,and operative time.Sufficient preoperative evaluation shall be carried out,appropriate surgical approach shall be selected,and surgical techniques shall be improved to shorten operative time.

Objective:To analyze the efficacy of laparoscopic partial splenectomy and devascularization (LPSPD), open partial splenectomy and devascularization (OPSPD), laparoscopic total splenectomy and devascularization (LTSPD), and open total splenectomy and devascularization (OTSPD) in the treatment of portal hypertension.Methods:Clinical data of 128 patients with portal hypertension admitted to the Department of Hepatobiliary and Pancreatic Surgery of the Affiliated Hospital of Qinghai University and the General Surgery Department of the Fifth Medical Center of the Chinese PLA General Hospital from May 2018 to May 2022 were retrospectively analyzed, including 69 males and 59 females, aged 51.0±10.9 years. According to different surgical methods, patients were divided into four groups, namely the LPSPD group ( n=30), the OPSPD group ( n=32), the LTSPD group ( n=31), and the OTSPD group ( n=35). Operation time, postoperative hospitalization time, postoperative complications such as newly occurred PVT, etc of the four groups of patients were compared. Results:The operation times of the LPSPD, OPSPD, LTSPD and OTSPD group were 240.0 (180.0, 399.0), 209.5 (169.0, 259.0), 207.0 (175.3, 297.5) and 200.0 (162.0, 264.0) minutes, respectively. The postoperative hospital stays were 8.0 (7.0, 12.0), 10.0 (8.3, 11.8), 11.0 (9.0, 13.0) and 13.0 (11.0, 15.0) days, respectively. The incidences of newly occurred PVT after surgery were 3.3% (1/30), 3.1% (1/32), 19.4% (6/31), and 20.0% (7/35), respectively. The above indicators were compared among the four groups respectively, and the differences were statistically significant (all P<0.05). The postoperative hospital stay of the LPSPD group was shorter than that of the LTSPD group [8.0 (7.0, 12.0) vs 11.0 (9.0, 13.0), d, Z=-3.93], and the postoperative hospital stay of the OPSPD group was also shorter than that of the OTSPD group [10.0 (8.3, 11.8) vs 13.0 (11.0, 15.0), d, Z=-3.56; all P<0.001]. The incidence of newly occurred PVT after surgery in the partial splenectomy group (LPSPD and OPSPD) was 3.2% (2/62), which was lower than that in the total splenectomy group [LTSPD and OTSPD, 19.7% (13/66), χ2=8.38, P=0.004]. Conclusion:Compared to total splenectomy, partial splenectomy might be favorable for the shortened postoperative hospital stay and lower incidence of newly occurred portal vein thrombosis.

Objectives:To investigate the factors influencing intraoperative blood loss in spinal metastatic tu-mor surgery and provide scientific evidence for personalized surgical planning and blood loss control measures in clinical practice.Methods:We retrospectively analyzed the clinical data of 223 patients with spinal metastatic tumors treated at the Spinal Surgery Department of Beijing Shijitan Hospital Affiliated to Capital Medical University from January 2019 to September 2024.The surgical methods included vertebroplasty,tumor resection or partial resection,vertebral body reconstruction and internal fixation,and palliative surgery.Data collected included patient demographics(age,sex,BMI,etc.),tumor characteristics(primary tumor type,vertebral metastasis location and involvement area,number of extraspinal metastases,etc.),surgical factors(surgical ap-proach,robotic assistance,operative time,etc.),and intraoperative blood loss.Univariate regression analysis was conducted on each of the above indicators,and multivariate regression analysis was performed on the in-dicators with statistical significance to identify the influence of each factor on intraoperative blood loss.Re-sults:The intraoperative blood loss was 300mL(10,1000mL).Among the 223 patients,the proportion of metastasis in the thoracic and lumbar vertebrae was relatively high,and the blood loss was relatively signifi-cant in hypervascular tumors.The amount of blood loss in the tumor resection or partial resection and verte-bral body reconstruction and internal fixation groups was greater than that in the other two groups.Univariate analysis revealed that BMI(P＜0.001),primary tumor type(P＜0.001),vertebral metastasis location(P＜0.001),verte-bral involvement area(P＜0.001),number of extraspinal metastases(P=0.03),surgical approach(P＜0.001),robotic assistance(P＜0.001),and operative time(P＜0.001)were associated with intraoperative blood loss.Multivariate analysis identified BMI(P＜0.001),primary tumor type(P=0.02),vertebral metastasis location(P=0.02)and involve-ment area(P=0.004),surgical approach(P=0.04),and operative time(P＜0.001)as the independent predictors of intraoperative blood loss.Conclusions:Intraoperative blood loss in spinal metastatic tumor surgery is influ-enced by multiple factors,including BMI,primary tumor type,vertebral metastasis location and involvement area,surgical approach,and operative time.Sufficient preoperative evaluation shall be carried out,appropriate surgical approach shall be selected,and surgical techniques shall be improved to shorten operative time.

Objective:To analyze the efficacy of laparoscopic partial splenectomy and devascularization (LPSPD), open partial splenectomy and devascularization (OPSPD), laparoscopic total splenectomy and devascularization (LTSPD), and open total splenectomy and devascularization (OTSPD) in the treatment of portal hypertension.Methods:Clinical data of 128 patients with portal hypertension admitted to the Department of Hepatobiliary and Pancreatic Surgery of the Affiliated Hospital of Qinghai University and the General Surgery Department of the Fifth Medical Center of the Chinese PLA General Hospital from May 2018 to May 2022 were retrospectively analyzed, including 69 males and 59 females, aged 51.0±10.9 years. According to different surgical methods, patients were divided into four groups, namely the LPSPD group ( n=30), the OPSPD group ( n=32), the LTSPD group ( n=31), and the OTSPD group ( n=35). Operation time, postoperative hospitalization time, postoperative complications such as newly occurred PVT, etc of the four groups of patients were compared. Results:The operation times of the LPSPD, OPSPD, LTSPD and OTSPD group were 240.0 (180.0, 399.0), 209.5 (169.0, 259.0), 207.0 (175.3, 297.5) and 200.0 (162.0, 264.0) minutes, respectively. The postoperative hospital stays were 8.0 (7.0, 12.0), 10.0 (8.3, 11.8), 11.0 (9.0, 13.0) and 13.0 (11.0, 15.0) days, respectively. The incidences of newly occurred PVT after surgery were 3.3% (1/30), 3.1% (1/32), 19.4% (6/31), and 20.0% (7/35), respectively. The above indicators were compared among the four groups respectively, and the differences were statistically significant (all P<0.05). The postoperative hospital stay of the LPSPD group was shorter than that of the LTSPD group [8.0 (7.0, 12.0) vs 11.0 (9.0, 13.0), d, Z=-3.93], and the postoperative hospital stay of the OPSPD group was also shorter than that of the OTSPD group [10.0 (8.3, 11.8) vs 13.0 (11.0, 15.0), d, Z=-3.56; all P<0.001]. The incidence of newly occurred PVT after surgery in the partial splenectomy group (LPSPD and OPSPD) was 3.2% (2/62), which was lower than that in the total splenectomy group [LTSPD and OTSPD, 19.7% (13/66), χ2=8.38, P=0.004]. Conclusion:Compared to total splenectomy, partial splenectomy might be favorable for the shortened postoperative hospital stay and lower incidence of newly occurred portal vein thrombosis.

Objectives:To compare the short-term effectiveness and safety between robot-assisted cortical bone trajectory screw(CBTS)and traditional pedicle screw(TPS)fixations in posterior lumbar interbody fusion(PLIF)for lumbar spinal stenosis with osteoporosis.Methods:We retrospectively analyzed the clinical data of 113 patients who underwent robot-assisted PLIF and internal fixation in our hospital between September,2018 and June,2021.The patients were divided into two groups according to the internal fixation method.55 pa-tients fixed with CBTS were included in the CBTS group,and 58 patients fixed with TPS were included in the TPS group.The general data[age,sex ratio,height,weight,body mass index(BMI),hip bone mineral densi-ty(BMD)],surgical related data(operative time,incision length,intraoperative blood loss),perioperative indicators(postoperative length of hospital stay,surgical complications,screw loosening rate,adjacent facet joint violation rate,preoperative and postoperative blood glucose),and visual analogue scale(VAS)score of pain and Oswestry disability index(ODI)before and after surgery were recorded and compared.Results:There was no significant difference in age,sex ratio,height,weight,BMI and hip BMD between the two groups(P＞0.05).There was no significant difference in operative time,postoperative length of hospital stay,surgical complications,preoperative VAS score and ODI,and ODI at 1 month and 6 months after operation between the two groups(P＞0.05).The intraoperative blood loss,length of incision and VAS score at 6 months after operation in the CBTS group were significantly lower than those in the TPS group(500mL vs 600mL,P=0.007;8cm vs 10cm,P=0.006;2 vs 3,P＜0.001).There was no significant difference in blood glucose before operation and 1 day after operation between the two groups(P＞0.05),while at 1 week after operation,the CBTS group was significantly lower than the TPS group(4.75mmol/L vs 5.57mmol/L,P=0.041).At the final follow-up,the rates of screw loosening and adjacent facet joint violation in CBTS group were significantly lower than those in TPS group(1.68％vs 4.52％,P=0.044 and 13.83％vs 26.53％,P=0.029).Conclusions:For patients with lumbar spinal stenosis combined with osteoporosis,PLIF with robot-assisted CBTS fixation is less in surgical trauma,faster in early postoperative recovery,and fewer in screw-related complications than with TPS fixation.

Objectives:To compare the short-term effectiveness and safety between robot-assisted cortical bone trajectory screw(CBTS)and traditional pedicle screw(TPS)fixations in posterior lumbar interbody fusion(PLIF)for lumbar spinal stenosis with osteoporosis.Methods:We retrospectively analyzed the clinical data of 113 patients who underwent robot-assisted PLIF and internal fixation in our hospital between September,2018 and June,2021.The patients were divided into two groups according to the internal fixation method.55 pa-tients fixed with CBTS were included in the CBTS group,and 58 patients fixed with TPS were included in the TPS group.The general data[age,sex ratio,height,weight,body mass index(BMI),hip bone mineral densi-ty(BMD)],surgical related data(operative time,incision length,intraoperative blood loss),perioperative indicators(postoperative length of hospital stay,surgical complications,screw loosening rate,adjacent facet joint violation rate,preoperative and postoperative blood glucose),and visual analogue scale(VAS)score of pain and Oswestry disability index(ODI)before and after surgery were recorded and compared.Results:There was no significant difference in age,sex ratio,height,weight,BMI and hip BMD between the two groups(P＞0.05).There was no significant difference in operative time,postoperative length of hospital stay,surgical complications,preoperative VAS score and ODI,and ODI at 1 month and 6 months after operation between the two groups(P＞0.05).The intraoperative blood loss,length of incision and VAS score at 6 months after operation in the CBTS group were significantly lower than those in the TPS group(500mL vs 600mL,P=0.007;8cm vs 10cm,P=0.006;2 vs 3,P＜0.001).There was no significant difference in blood glucose before operation and 1 day after operation between the two groups(P＞0.05),while at 1 week after operation,the CBTS group was significantly lower than the TPS group(4.75mmol/L vs 5.57mmol/L,P=0.041).At the final follow-up,the rates of screw loosening and adjacent facet joint violation in CBTS group were significantly lower than those in TPS group(1.68％vs 4.52％,P=0.044 and 13.83％vs 26.53％,P=0.029).Conclusions:For patients with lumbar spinal stenosis combined with osteoporosis,PLIF with robot-assisted CBTS fixation is less in surgical trauma,faster in early postoperative recovery,and fewer in screw-related complications than with TPS fixation.

Objective:To analyze the factors influencing prognosis of intrahepatic cholangiocarcinoma (ICC) after surgical resection.Methods:The clinical data of patients diagnosed with ICC and who underwent surgical resection from December 2015 to December 2019 at the Fifth Medical Center of PLA General Hospital were retrospectively analyzed. Of 39 patients who were included in this study, there were 23 males and 16 females, with age of (54.1±7.2) years old. The body mass index, hepatitis B virus infection status, tumor diameter, degree of differentiation, microvascular tumor thrombus, lymph node metastasis, and serum levels of carbohydrate antigen 19-9 (CA19-9) were analyzed as risk factors affecting postoperative recurrence and survival.Results:The median times to recurrence were significantly better in patients with a tumour length <5 cm (11 vs. 5 months), patients without microvascular tumor thrombus (54 vs. 6 months) and patients without lymph node metastasis (8 vs. 5 months) (all P<0.05). The median survival of patients with CA19-9≥100 U/ml was significantly shorter than that of patients with CA19-9<100 U/ml, (9 vs. 27 months, P<0.05). Tumor diameter>5 cm, microvascular tumor thrombus, lymph node metastasis, and CA19-9 ≥100 U/ml are risk factors affecting the recurrence time after ICC resection, CA19-9 ≥100 U/ml is a risk factor affecting survival time after ICC resection. Conclusion:Tumor diameter, microvascular tumor thrombus, lymph node metastasis and CA19-9 can be used to estimate the risk of ICC recurrence, and CA19-9 level can be used to estimate postoperative survival of ICC patients after resection.

Objective:To study the efficacy of direct intrahepatic portosystemic shunt (DIPS) in treatment of Budd-Chiari syndrome (BCS).Methods:From January 1, 2015 to June 31, 2017, consecutive patients with BCS who were treated with DIPS at the Department of Interventional Therapy of Beijing Shijitan Hospital, the Liver Disease Research Center of Beijing Friendship Hospital and the General Surgery Department of Beijing Ditan Hospital were retrospectively analyzed. The symptoms, physical signs (including abdominal distension, ascites, pleural effusion, splenomegaly, hepatic encephalopathy) and perioperative laboratory results of these patients were collected and analyzed. Biochemical indicators including alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), direct bilirubin (DBil), and portal pressure gradient were compared before and 2 weeks after treatment. The patients were followed up for at least 3 years to assess their clinical symptoms, patency of shunt, oncological status and survival.Results:Of 67 patients with BCS who were included in the study, there were 45 males and 22 females, aged (38.12±23.22) years. The BCS classification of these patients were hepatic vein type ( n=65), including 62 patients with complete hepatic vein obstruction, 3 patients with hepatic vein occlusion due to thrombosis, and 2 patients with mixed hepatic vein and inferior vena cava occlusion. All 67 patients underwent DIPS with 93 stents being implanted. In addition, 43 patients underwent gastric coronary vein embolization, and 2 patients with mixed type of BCS underwent inferior vena cava stenting. The portal pressure gradient decreased from (22.17±9.16) mmHg (1 mmHg=0.133 kPa) to (9.87±4.75) mmHg, the difference was statistically significant ( P<0.05). Abdominal distension was relieved, at one month and ascites completely subsided in 3 months after operation. The liver congestion and swelling were obviously relieved. Comparison of patients 2 weeks after operation and before operation, ALT decreased from (65.28±27.75) U/L to (28.43±13.46)U/L, AST from (68.75±29.23) U/L to (26.92±13.33)U/L, TBil from (175.31±80.48)μmol/L to (45.08±26.54)μmol/L, DBil from (127.55±44.65)μmol/L to (35.12±10.77)μmol/L, and albumin increased from (31.56±7.22) g/L to (44.18±11.36)g/L, the difference was statistically significant (all P<0.05). All patients were followed up for at least 3 years. Shunt stenosis was detected in 5 patients (7.46%) with shunt expansion being performed, variceal bleeding in 2 patients (2.99%), ascites recurrence in 4 patients (5.97%) and hepatic encephalopathy in 2 patients (2.99%). No patients were diagnosed with hepatic cancer, and no patients died. Conclusion:DIPS was efficacious, safe and reliable to that BCS patients. It rapidly reduced portal venous pressure, relieved liver congestion, and restored liver morphology and liver function in these patients.

Objective To study whether portal vein thrombosis can be prevented by partial splenectomy combined with portoazygos devascularization,by preserving the integrity of the blood flow of the inferior splenic vessels.Methods 156 patients with portal hypertension and megalosplenia were divided into two groups.62 patients in group A who underwent partial splenectomy and 94 patients in group B who underwent total splenectomy.The postoperative complications,levels of WBC and PLT,volumes of residual spleen,hepatic vein pressure gradient (HVPG),and prevalence of portal vein thrombosis between the two groups were compared.Results The surgery time of group A was slightly higher than group B [(189.0± 38.5) vs.(128.0±36.3) min,P＜0.05].The blood loss of group A was slightly higher than that of group B [(328.0±68.9) vs.(294.0±49.1) ml,P＜0.05].The postoperative infection rate,change in HVPG and rehemorrhage rate between the two groups showed no significant differences (P＞0.05).The elevation in Leucocyte after operation of the two groups were the same,peaking on day 3.The platelet count of group A increased more gently than group B (2 weeks vs 1 week),and its peak was closer to the normal threshold (P＜0.05).The thrombosis rate of the portal vein system in group A was significantly lower than group B within 1 year (P＜0.01).The residual spleen did not enlarge after operation (P＞0.05).Conclusion Subtotal splenectomy combined with pericardial devascularization in patients with portal hypertension and megalosplenia preserved the blood flow of the subsplenic polar vessels and reduced the incidence of portal vein thrombosis.

Objective To study the impact of splenectomy and pericardial devascularization on the occurrence and development of portal vein thrombosis and the liver function in patients with cirrhosis complicated by portal hypertension.Methods 29 patients with cirrhosis and portal hypertension who underwent splenectomy and pericardial devascularization in the 302 Hospital of PLA from December 2012 to June 2013 were retrospectively studied.The incidences of PVT before and after operation were monitored.The liver function was assessed using the Child-Pugh classification.Results 29 patients with cirrhosis and portal hypertension underwent splenectomy and pericardial devascularization.The incidences of PVT in the preoperative period,12 days,3 months,6 months after operation were 10.3％,89.7％,51.7％,24.1％,respectively.The Child-Pugh scores in the preoperative period,12 days,3 months,6 months after operation were (5.2 ± 0.4),(5.6 ± 0.7),(5.2 ± 0.7),(5.3 ± 0.7),respectively.Conclusions The incidences of postoperative PVT increased after operation,but it decreased on long-term follow-up after operation.The liver function did not change.