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目的:探讨射频消融辅助开放手术姑息性治疗脊柱转移癌的近期临床效果。方法:回顾性总结2012年4月~2015年1月接受射频消融辅助开放手术姑息性治疗的30例脊柱转移癌患者,其中男性17例,女性13例;年龄56±14岁(17~80岁);单纯胸椎17例,单纯腰椎9例,胸腰椎均受累4例;原发肿瘤包括肺癌6例,肾癌5例,肝癌、乳腺癌、多形性未分化肉瘤、前列腺癌、甲状腺癌各2例,其他脏器来源转移癌9例;患者均在后路开放手术过程中接受病灶射频消融。观测患者术中出血量、术后并发症、术后疼痛和神经功能恢复情况及肿瘤局部控制情况。结果:患者平均术中出血量1083±1193ml(250~5400ml),并发症包括脑脊液漏3例、无症状骨水泥渗漏2例、术后血肿形成1例、伤口感染1例,其中脑脊液漏患者经保守治疗后好转,硬膜外血肿行急诊血肿清除后神经功能恢复,伤口感染经清创后痊愈。患者术前平均疼痛VAS评分4.3分,术后1个月时平均1.3分,差异有统计学意义(P=0.0254),共计26例(86.7%)患者术后获得疼痛缓解。所有患者术后神经功能获得改善或保持稳定;平均随访10±8个月,随访期内3例患者脊柱原病灶部位出现进展。结论:射频消融辅助开放手术方式姑息性治疗脊柱转移癌,可以在手术创伤较小的前提下获得较低的并发症发生率、良好的疼痛和神经功能改善及满意的肿瘤局部控制效果。
Objective: To investigate the short-term clinical effect of radiofrequency ablation assisted open surgery for palliative treatment of spinal metastases. Methods: Thirty patients with spinal metastases undergoing radiofrequency ablation assisted open surgery between April 2012 and January 2015 were retrospectively reviewed, including 17 males and 13 females; aged 56 ± 14 (17 to 80 years ); Simple thoracic in 17 cases, simple lumbar in 9 cases, thoracolumbar involvement in 4 cases; primary tumor including lung cancer in 6 cases, 5 cases of renal cell carcinoma, liver cancer, breast cancer, pleomorphic undifferentiated sarcoma, prostate cancer, thyroid cancer 2 cases, and 9 cases of metastases from other organs; patients underwent radiofrequency catheter ablation in the course of posterior open surgery. Observed intraoperative blood loss, postoperative complications, postoperative pain and neurological recovery and local tumor control. Results: The mean intraoperative blood loss was 1083 ± 1193ml (250 ~ 5400ml). Complications included cerebrospinal fluid leakage in 3 cases, asymptomatic bone cement leakage in 2 cases, postoperative hematoma formation in 1 case and wound infection in 1 case. Cerebrospinal fluid leakage After conservative treatment improved, epidural hematoma in emergency hematoma cleared nerve function recovery, wound infection recovered after debridement. The average preoperative pain VAS score 4.3 points, an average of 1.3 points after 1 month, the difference was statistically significant (P = 0.0254), a total of 26 patients (86.7%) patients with pain relief. The neurological function of all patients was improved or remained stable after an average follow-up of 10 ± 8 months. The progress of primary spinal lesions occurred in 3 patients during the follow-up period. Conclusion: The radiofrequency ablation assisted open surgery for palliative treatment of spinal metastases can achieve a lower incidence of complications, good pain and neurological function, and satisfactory local tumor control effect with less surgical trauma.