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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。
Objective: To explore the clinical effect of total spondylectomy on metastatic spine cancer and evaluate the new metastasis after operation. Methods: A retrospective analysis of 11 cases of spinal metastases treated with total spondylectomy from January 2004 to December 2014 in our hospital was retrospectively analyzed. The primary tumor was thyroid carcinoma in 3 cases, breast carcinoma in 5 cases, renal carcinoma in 1 case, lung carcinoma 1 case, pancreatic cancer in 1 case. 5 cases of thoracolumbar spine, all underwent whole spine lump resection, lower cervical spine and cervical thoracic vertebra 6 cases, all underwent total spondylolisthesis resection. Preoperative Tomita score, 2 points in 3 cases, 3 points in 5 cases, 3 points more than 3 cases; preoperative visual analogue pain score (visual analogue score, VAS) was 7.18 ± 1.19 points. All patients according to the neurological score of spinal cord injury (Frankel classification): E grade in 6 cases, D grade in 4 cases, C grade in 1 case. Results: All the cases were successfully completed and were followed up for 358.3 ± 155.9min and 1850.0 ± 969.8ml respectively. There was no residual tumor at 1 ~ 2 weeks postoperatively. There were 3 cases of postoperative complications, Pleural effusion pleural effusion with atelectasis in 1 case, cerebrospinal fluid leakage and pleural injury in 1 case, aspiration pneumonia and laryngeal nerve paralysis in 1 case, were conservative treatment after 6 weeks improved. Postoperative pain were significantly improved, VAS score decreased to 1.64 ± 0.77 points (P <0.0001), postoperative pain improved the good rate was 100%; postoperative no neurological damage worse cases, preoperative neurological deficits were postoperative All improve one level. The patients were followed up for 18-73 months (mean 42.4 ± 16.2 months) and 4 died, all of whom died of advanced cancer. No recurrence occurred in 3 (27.3%) patients during the follow-up period. Four patients (36.4%) had local recurrence after operation, of which 1 patient (20%) recurred after the resection and 3 patients (50% , The local recurrence rate after the resection was higher than that of the subtotal resection (P <0.05). Four cases (36.4%) of new distant metastases (36.4% Metastases. CONCLUSION: Total spondylotomy is an effective surgical treatment of spinal metastases, which can significantly improve the pain and neurological function of patients. However, the rate of new metastases in the distant area after surgery is high, which needs attention.