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目的:探讨术中射频消融(RFA)后再行病灶刮除术治疗脊柱转移瘤的可行性及疗效。方法:2004年～2006年,对11例脊柱转移瘤患者术中实施RFA后再行病灶刮除术,将FRA前后病灶标本进行光镜和电镜病理检查,随访患者疼痛缓解情况及肿瘤复发情况。结果:术中未出现脊髓和神经根损伤,RFA后瘤组织固缩,刮除顺利,出血量350～3800ml,平均1024.5ml。全部病例得到6个月以上随访,平均9.8个月,全部患者生存期超过6个月,VAS评分术前平均5.8分,术后6个月时平均1.9分。1例出现局部肿瘤复发。RFA前的标本光、电镜检查均未见肿瘤组织坏死。RFA后光镜检查3例无明显坏死,9例肿瘤细胞完全坏死;电镜检查10例肿瘤细胞完全坏死,1例肿瘤细胞部分坏死,1例无明显坏死。结论:术中RFA后再行病灶刮除治疗脊柱转移瘤安全可行,有利于肿瘤的刮除,减少局部复发的风险。
Objective: To investigate the feasibility and efficacy of intraoperative radiofrequency ablation (RFA) followed by focal curettage in the treatment of spinal metastases. Methods: From 2004 to 2006, 11 cases of spinal metastases were treated with RFA before and after lesion resection. The lesions of front and rear of FRA were examined by light microscopy and electron microscopy. The patients were followed up for pain relief and tumor recurrence. Results: There was no injury of spinal cord and nerve root during operation. After RFA, the tumor shrinks and the curettage goes smoothly. The blood loss is 350 ~ 3800ml with an average of 1024.5ml. All cases were followed up for more than 6 months with an average of 9.8 months. All patients survived for more than 6 months. The VAS score was 5.8 before surgery and 1.9 after 6 months. 1 case of local tumor recurrence. Specimens before RFA light, electron microscopy showed no tumor necrosis. There was no obvious necrosis in 3 cases after RFA and 9 cases of tumor cells completely necrotic. Electron microscopy showed that 10 cases of tumor cells were completely necrotic, 1 case of tumor cells were partially necrotic, and 1 case had no obvious necrosis. Conclusion: It is safe and feasible to cure the spinal metastases by RFA after RFA, which is good for tumor curettage and reduce the risk of local recurrence.