摘要
目的 ：探索脊柱转移癌全脊椎切除术后临床疗效情况,评估术后新发转移情况。方法 ：回顾性分析我院2004年1月～2014年12月行全脊椎切除术治疗的脊柱转移癌患者11例,原发灶为甲状腺癌3例,乳腺癌5例,肾癌1例,肺癌1例,胰腺癌1例。胸腰椎5例,均行全脊椎整块切除,下颈椎及颈胸椎6例,均行全脊椎分块切除。术前Tomita评分,2分3例,3分5例,3分以上3例;术前疼痛视觉模拟评分（visual analogue score,VAS）为7.18±1.19分。所有患者根据脊髓损伤神经功能评分标准（Frankel分级）：E级6例,D级4例,C级1例。结果：所有病例手术均顺利完成并获得随访,手术时间358.3±155.9min,手术出血量1850.0±969.8ml;术后1～2周复查均未见手术部位癌残余,术后出现并发症3例,胸膜损伤胸腔积液伴肺不张1例,脑脊液漏及胸膜损伤1例,吸入性肺炎及喉反神经麻痹1例,均保守治疗6周后好转。术后患者疼痛均明显改善,VAS评分降至1.64±0.77分（P〈0.0001）,术后疼痛改善优良率为100%;术后无神经功能损害加重病例,术前有神经功能损害者术后均改善一等级。术后随访18～73个月（平均42.4±16.2个月）,死亡4例,均因癌症晚期死亡。随访期内无瘤生存3例（27.3%）,术后局部复发4例（36.4%）,其中整块切除术后复发1例（20%）,分块切除术后复发3例（50%）,整块切除术后局部复发率数值较分块切除高（P〈0.05）;术后1年内出现远处新发转移（手术部位外新发转移灶）4例（36.4%）,均为骨转移灶。结论：全脊椎切除手术是治疗脊柱转移癌的一种有效手术方式,能明显改善患者疼痛及神经功能;但是术后远处新发转移率较高,需引起重视。
Objectives： To investigate the overall effects for spinal metastasis after total spondylectomy, espe-cially the new distant metastasis after operation. Methods： From January 2004 to December 2014, 11 patients with spinal metastasis underwent total spondylectomy in our department were reviewed retrospectively. Histo-logical results included 3 thyroid carcinoma, 5 breast carcinoma, 1 renal carcinoma, 1 lung cancer, and 1pancreatic carcinoma. Five patients with thoracolumbar spinal metastasis all underwent total en bloc spondylectomy（TES）, 6 patients with subaxial or cervicothoracic junction spinal metastasis received piecemeal excision. The Tomita scores were 2 points in 3 patients, 3 points in 5, and more than 3 points in 3; the preoperative visual analogue score（VAS） was 7.18 ±1.19; the Frankel grade of neurologic function was E in 6,D in 4, C in 1. Results： All operations were successful and the patients were followed up. The average oper-ation time was 358.3 ±155.9min, the average blood loss was 1850.0 ±969.8ml, the surgical sites showed no residual within 1-2 weeks after surgery, and 3 cases had postoperative complications which relieved after con-servative treatment. All patients showed significant pain relief（P〈0.001）, the VAS score decreased to 1.64±0.77, with the excellent and good rate of 100%. There was no neurological deficit, the Frankel grades of pa-tients with neurological dysfunction all improved by 1 grade. All patients received postoperative follow-up with an average time of 42.4±16.2 months（18-73 months）, 4 cases died due to the progression of cancer. Three cases（27.3%） had disease-free survival, 4 cases（36.4%） had local recurrence, including 1 case（20%） with TES and 3 cases（50%） with piecemeal excision, so the local recurrence rate of TES was higher than that of piecemeal excision（P〈0.05）. Four cases（36.4%） had new distant metastasis in 1 year after total spondylectmoy,all were bone metastases. Conclusions： Total spondylectomy is an effective method for the cases under strict indications and can significantly improve the pain and neurofunction; while the rate of new distant metastasis after total spondylectomy is high, which should be paid attention.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2016年第5期421-427,共7页
Chinese Journal of Spine and Spinal Cord
关键词
脊柱转移癌
全脊椎切除
局部复发
远处新发转移
Spinal metastasis
Total spondylectomy
Local recurrence
New distant metastasis
