脊柱转移癌全脊椎切除术后临床疗效分析

The analysis of overall effects for spinal metastasis after total spondylectomy

中文关键词:  脊柱转移癌  全脊椎切除  局部复发  远处新发转移

英文关键词:Spinal metastasis  Total spondylectomy  Local recurrence  New distant metastasis

中文摘要:

  【摘要】 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。

英文摘要:

  【Abstract】 Objectives: To investigate the overall effects for spinal metastasis after total spondylectomy, especially the new distant metastasis after operation. Methods: From January 2004 to December 2014, 11 patients with spinal metastasis underwent total spondylectomy in our department were reviewed retrospectively. Histological results included 3 thyroid carcinoma, 5 breast carcinoma, 1 renal carcinoma, 1 lung cancer, and 1 pancreatic carcinoma. Five patients with thoracolumbar spinal metastasis all underwent total en bloc spondylectomy(TES), 6 patients with subaxial or cervicothoracic junction spinal metastasis received piecemeal excision. The Tomita scores were 2 points in 3 patients, 3 points in 5, and more than 3 points in 3; the preoperative visual analogue score(VAS) was 7.18±1.19; the Frankel grade of neurologic function was E in 6, D in 4, C in 1. Results: All operations were successful and the patients were followed up. The average operation time was 358.3±155.9min, the average blood loss was 1850.0±969.8ml, the surgical sites showed no residual within 1-2 weeks after surgery, and 3 cases had postoperative complications which relieved after conservative treatment. All patients showed significant pain relief(P<0.001), the VAS score decreased to 1.64±0.77, with the excellent and good rate of 100%. There was no neurological deficit, the Frankel grades of patients with neurological dysfunction all improved by 1 grade. All patients received postoperative follow-up with an average time of 42.4±16.2 months(18-73 months), 4 cases died due to the progression of cancer. Three cases(27.3%) had disease-free survival, 4 cases(36.4%) had local recurrence, including 1 case(20%) with TES and 3 cases(50%) with piecemeal excision, so the local recurrence rate of TES was higher than that of piecemeal excision(P<0.05). Four cases(36.4%) had new distant metastasis in 1 year after total spondylectmoy, all were bone metastases. Conclusions: Total spondylectomy is an effective method for the cases under strict indications and can significantly improve the pain and neurofunction; while the rate of new distant metastasis after total spondylectomy is high, which should be paid attention.