椎体“塌陷式”病灶切除术治疗胸腰椎脊柱转移瘤的临床疗效

Clinical efficacy of vertebral "Collapse" lesion resection surgery for treating thoracolumbar spinal metastases

中文关键词:  脊柱转移瘤  分离手术  手术治疗  椎体“塌陷式”病灶切除术  微波

英文关键词:Spinal metastases  Separation surgery  Surgical treatment  Vertebral "Collapse" resection  Microwave

中文摘要:

  【摘要】 目的：通过与分离手术对比，探讨椎体“塌陷式”病灶切除术治疗胸腰椎脊柱转移瘤的临床疗效及术后复发率。方法：回顾性研究2018年12月~2022年12月天津大学天津医院收治的78例胸腰椎脊柱转移瘤患者，其中男42例（53.8%），女36例（46.2%），年龄61.9±10.6（34~76）岁。根据治疗方式分为分离手术组（21例）和“塌陷式”切除组（57例）。术后2~3周，待伤口愈合后根据原发肿瘤类型予以放疗、化疗或靶向药物等综合治疗。统计两组患者手术时间、术中失血量、引流量、Frankel脊髓损伤分级、局部复发率以及围手术期并发症情况，患者术前、术后7d及末次随访时的疼痛视觉模拟量表（visual analogue scale，VAS）评分。结果：手术时间及术中出血量方面，“塌陷式”切除组（328.7±89.2min，782.5±89.2mL）显著性高于分离手术组（243.2±89.2min，585.7±89.2mL）（P＜0.05）。术后引流量“塌陷式”切除组（698.2±230.2mL）与分离手术组（674.7±180.7mL）相比，差异无统计学意义（P＞0.05）。随访期间，分离手术组所有患者术后均进行立体定向放疗，“塌陷式”切除组患者中10例（21.2%）进行了放疗，其余47例（78.8%）患者未进行放疗，但进行了靶向、免疫、化疗等综合治疗。分离手术组患者复发率为9.5%（2/21）。“塌陷式”切除+放疗组患者局部复发1例，复发率约10%（1/10）；“塌陷式”切除+未放疗组患者局部复发3例，复发率为6.4%（3/47）。“塌陷式”切除组患者总体复发率7.0%（4/57）。两种手术术后复发率无明显统计学差异（P=0.708）。分离手术组术后伤口感染1例，1例患者术后放疗后伤口2个月后裂开，1例患者出现硬膜外血肿压迫；“塌陷式”切除组患者脑脊液漏继发感染1 例，伤口浅表感染1例。两组患者术后7d的VAS评分均较术前明显降低（P<0.05），末次随访时VAS评分与术前VAS评分比较有显著性差异（P<0.05）。术后7d和末次随访时VAS评分两组患者之间无显著统计学差异（P＞0.05）。除5例Frankle A~D级患者神经功能无明显改善外，其余73例脊柱转移瘤患者神经功能均呈现好转，且存在不同程度恢复（至少1个等级），改善率为93.6%（73/78例）。结论：椎体“塌陷式”病灶切除术治疗胸腰椎肿瘤，无须术后放疗，其肿瘤复发率与接受分离手术+放疗患者无差异。

英文摘要:

  【Abstract】 Objectives: To explore the clinical efficacy and the postoperative recurrence rate of the vertebral "Collapse" lesion resection for treating thoracolumbar spinal metastases compared to separation surgery. Methods: A retrospective study was conducted on 78 patients with thoracolumbar spinal metastases treated at Tianjin University General Hospital from December 2018 to December 2022. There were 42 males(53.8%) and 36 females(46.2%), with a mean age of 61.9±10.6 years(range 34-76 years). The patients were divided into separation surgery group(21 cases) and "Collapse" resection group(57 cases). Two to three weeks after surgery, radiotherapy, chemotherapy or targeted drugs were given according to the type of primary tumor after wound healing. The data on operative time, intraoperative blood loss, drainage volume, Frankel classification for spinal cord injury, and visual analogue scale(VAS) scores for pain preoperatively, 7d after operation and at final follow-up, as well as local recurrence rates and perioperative complications were collected. Results: The operative time and intraoperative blood loss in the "Collapse" resection group(328.7±89.2min, 782.5±89.2mL) were significantly higher than those in the separation surgery group(243.2±89.2min, 585.7±89.2mL)(P<0.05). There was no statistically significant difference in postoperative drainage volume between the two groups ("Collapse" resection group 698.2±230.2mL vs separation surgery group 674.7±180.7mL)(P>0.05). During follow-up, all the patients in the separation surgery group received stereotactic radiotherapy postoperatively; While 10 patients(21.2%) in the "Collapse" resection group underwent radiotherapy, and the remaining 47(78.8％) patients received targeted, immunological, or chemotherapy as part of comprehensive treatment. The recurrence rate in the separation surgery group was approximately 9.5%(2/21). Among the patients who received "Collapse" resection plus radiotherapy, there was 1 local recurrence, resulting in a recurrence rate of 10%(1/10), while the patients who didn′t receive radiotherapy experienced 3 local recurrences, with a recurrence rate of 6.4%(3/47). The overall recurrence rate for patients in the "Collapse" resection group was 7.0%(4/57). There was no statistically significant difference in recurrence rates between the two surgical procedures(P=0.708). In the separation surgery group, postoperative complications included one case of wound infection, one case of wound dehiscence two months after postoperative radiotherapy, and one case of epidural hematoma causing compression. In the group of "Collapse" resection, complications included one case of cerebrospinal fluid leakage with secondary infection and one case of superficial wound infection. VAS scores on 7d postoperatively significantly decreased compared to preoperative scores in both groups(P<0.05), and there were significant differences in VAS scores at final follow-up compared to preoperative scores(P<0.05). No statistical difference in VAS scores was observed between the two groups on 7d postoperatively and at final follow-up(P>0.05). Except for 5 Frankel A-D grade patients with no significant improvement in neurological function, the remaining 73 patients showed no deterioration in neurological function, with varying degrees of recovery of at least 1 grade, yielding an improvement rate of 93.6%(73/78). Conclusions: The vertebral "Collapse" resection for thoracolumbar spinal tumors does not require postoperative radiotherapy, as the tumor recurrence rate is comparable to that of patients treated with separation surgery followed by radiotherapy.