胸椎转移性肿瘤的手术方式选择及疗效分析

Surgical treatment and outcome of thoracic spinal metastasis

中文关键词:  胸椎转移癌  手术  生存时间  全脊椎整块切除

英文关键词:Thoracic vertebra metastases tumors  Surgery  Survival time  Total en bolc spondylectomy

中文摘要:

  【摘要】 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。

英文摘要:

  【Abstract】 Objectives: To discuss the surgical treatment and outcome of thoracic spine metastatic.tumors. Methods: From July 2005 to December 2009, 40 patients with thoracic metastatic tumors undergoing surgery were analyzed. These included 27 males and 13 females with an average age of 58.8 years(range 23-79). The primary tumor included 11 pulmonary carcinomas, 8 mammary adenocarcinomas, 6 renal carcinomas, 4 thyroid carcinomas, 3 esophageal carcinomas, 3 hepatic carcinomas, 1 carcinoma of bladder, 1 adipose sarcoma, 1 carcinoma of gastric cardia, 1 chondrosarcoma and 1 prostatic carcinoma. The Frankel grade was A in 7, B in 3, C in 10, D in 15, E in 5. The surgical methods included anterior corpectomy and fixation in 26 cases(lesions located at zone 4-9 by WBB classfication, average Tomita prognostic score of 5.5, range 4-6), posterior approach in 5 cases(lesions located at zone 1-3 or 10-12 by WBB classfication, average Tomita prognostic score of 7.0, range 6-8), combined anterior and posterior approach in 4 cases(lesions located at one or two vertebral bodies, average Tomita prognostic score of 4.0, range 3-5), posterior decompression and stabilization with percutaneous vertebroplasty in 5 cases(lesions located at zone 4-9 by WBB classification in multiple vertebral bodies, average Tomita prognostic score of 7.6, range 6-8). Clinical outcome was observed during follow-up. Results: Follow-up was obtained in 40 cases with a mean value of 12.4 months(range 6-36 months), 25 patients died and the mean life span was 10.7 months(range 6-20). The postoperative Frankel grade changed significantly and ended up with A in 1, B in 3, C in 3, D in 8 and E in 25. The average preoperative VAS score was 6.81±1.51, which decreased to 3.65±0.94(P<0.05). Conclusions: The surgical approach can improve the life quality of patients with thoracic spine metastasis, the patients′ general condition and tumors′ stage should be considered when choosing surgical techniques.