贺 曦,韦 峰,姜 亮,刘晓光,刘忠军.脊柱转移癌全脊椎切除术后临床疗效分析[J].中国脊柱脊髓杂志,2016,(5):421-427. |
脊柱转移癌全脊椎切除术后临床疗效分析 |
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 |
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。 |
The analysis of overall effects for spinal metastasis after total spondylectomy |
英文关键词:Spinal metastasis Total spondylectomy Local recurrence New distant metastasis |
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. |
投稿时间:2016-01-13 修订日期:2016-03-31 |
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