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目的:探讨胸椎转移性肿瘤的不同手术方式及治疗效果。方法:回顾性分析2005年7月～2009年12月接受手术治疗的40例胸椎转移瘤患者,男27例,女13例,平均年龄58.8岁(23～79岁)。原发肿瘤包括肺癌11例,乳腺癌8例,肾癌6例,甲状腺癌4例,食道癌3例,肝癌3例,膀胱癌、脂肪肉瘤、贲门癌、软骨肉瘤、前列腺癌各1例。Frankel分级:A级7例,B级3例,C级10例,D级15例,E级5例。行前路椎体切除内固定术26例(病灶位于WBB分区4~9区,Tomita术前评分4～6分,平均5.5分);后路肿瘤切除内固定术5例(病变位于WBB分区1~3区或10~12区,Tomita术前评分6～8分,平均7.0分);前后路联合切除内固定术4例(病变位于椎体前后方,累及1~2个椎体,Tomita术前评分3～5分,平均4.0分);后路肿瘤切除结合椎体成形术5例(跳跃多节段椎体病变,局限在WBB分区4~9区,Tomita术前评分6～8分,平均为7.6分)。随访观察治疗结果。结果:40例患者均获得随访,术后的平均随访时间为12.4个月(6～36个月),29例患者死亡,其术后平均生存时间为10.7个月(6～20个月)。末次随访时患者疼痛症状均明显改善,VAS评分由术前的6.81±1.51分降至3.65±0.94分(P<0.05);神经功能Frankel分级8例无变化(A级1例,C级1例,D级2例,E级4例),2例加重(1例C级至B级,1例E级至D级),其余30例均提高1～3级。结论:手术治疗能够明显改善胸椎转移性肿瘤患者的生活质量,应根据患者的全身情况及肿瘤分期选择适宜的手术方式。
Objective: To investigate the different surgical methods and therapeutic effects of metastatic thoracic tumors. Methods: Forty thoracic metastases from July 2005 to December 2009 were retrospectively analyzed. There were 27 males and 13 females, with an average age of 58.8 years (range, 23-79 years). Primary tumors included 11 cases of lung cancer, 8 cases of breast cancer, 6 cases of kidney cancer, 4 cases of thyroid cancer, 3 cases of esophageal cancer, 3 cases of liver cancer, 1 case of bladder cancer, liposarcoma, cardia cancer, chondrosarcoma and prostate cancer. Frankel classification: A grade in 7 cases, B grade in 3 cases, C grade in 10 cases, D grade in 15 cases, E grade in 5 cases. 26 patients underwent anterior resection and internal fixation of vertebral body (the lesions were located in 4 to 9 areas of WBB, and the preoperative score of Tomita was 4 to 6, with an average of 5.5 points); posterior resection and internal fixation in 5 cases ~ 3 or 10 ~ 12, Tomita preoperative score of 6 to 8, an average of 7.0 points); anterior and posterior combined resection and internal fixation in 4 cases (lesions located in the anterior and posterior vertebral body, involving 1 or 2 vertebrae, Tomita surgery The average score was 4.0); posterior resection combined with vertebroplasty in 5 cases (skip multi-segment vertebral disease, limited to WBB District 4 to 9, Tomita preoperative score of 6 to 8, An average of 7.6 points). Follow-up treatment results were observed. Results: All the 40 patients were followed up. The average follow - up time was 12.4 months (range, 6 to 36 months) and 29 patients died. The mean postoperative survival time was 10.7 months (6-20 months). VAS scores decreased from 6.81 ± 1.51 to 3.65 ± 0.94 (P <0.05) at the last follow-up. There was no change in Frankel grade of neurological function (1 in grade A and 1 in grade C) , D grade in 2 cases, E grade in 4 cases), 2 cases of exacerbation (1 case of C grade to B grade, 1 case of E grade to D grade), and the remaining 30 cases were increased by 1 to 3 levels. Conclusion: Surgical treatment can significantly improve the quality of life in patients with metastatic thoracic tumors. Patients should be selected according to the general condition and tumor staging appropriate surgical methods.