射频消融辅助开放手术姑息性治疗脊柱转移癌的近期临床疗效

Radiofrequency ablation during open surgery: a palliative treatment for spinal metastases

中文关键词:  脊柱转移癌  姑息性治疗  后路手术  射频消融

英文关键词:Spinal metastases  Palliative treatment  Posterior surgery  Radiofrequency ablation

中文摘要:

  【摘要】 目的：探讨射频消融辅助开放手术姑息性治疗脊柱转移癌的近期临床效果。方法：回顾性总结2012年4月～2015年1月接受射频消融辅助开放手术姑息性治疗的30例脊柱转移癌患者，其中男性17例，女性13例；年龄56±14岁（17～80岁）；单纯胸椎17例，单纯腰椎9例，胸腰椎均受累4例；原发肿瘤包括肺癌6例，肾癌5例，肝癌、乳腺癌、多形性未分化肉瘤、前列腺癌、甲状腺癌各2例，其他脏器来源转移癌9例；患者均在后路开放手术过程中接受病灶射频消融。观测患者术中出血量、术后并发症、术后疼痛和神经功能恢复情况及肿瘤局部控制情况。结果：患者平均术中出血量1083±1193ml（250～5400ml），并发症包括脑脊液漏3例、无症状骨水泥渗漏2例、术后血肿形成1例、伤口感染1例，其中脑脊液漏患者经保守治疗后好转，硬膜外血肿行急诊血肿清除后神经功能恢复，伤口感染经清创后痊愈。患者术前平均疼痛VAS评分4.3分，术后1个月时平均1.3分，差异有统计学意义（P=0.0254），共计26例（86.7%）患者术后获得疼痛缓解。所有患者术后神经功能获得改善或保持稳定；平均随访10±8个月，随访期内3例患者脊柱原病灶部位出现进展。结论：射频消融辅助开放手术方式姑息性治疗脊柱转移癌，可以在手术创伤较小的前提下获得较低的并发症发生率、良好的疼痛和神经功能改善及满意的肿瘤局部控制效果。

英文摘要:

  【Abstract】 Objectives: To investigate the outcome of radiofrequency ablation in surgery for spinal metastases. Methods: The study was a retrospective review of 30 cases of spinal neoplastic metastases treated in our center between April 2012 and January 2015, including 17 males and 13 females, with an average age of 56±14 years(range, 17-80 years). The affected vertebrae were located in thoracic spine(17 patients), lumbar spine(9 patients), both thoracic and lumbar spine(4 patients). The sites of primary cancer were: lung(6 cases), kidney(5 cases), each 2 cases at liver, mammary gland, soft tissue, prostate and thyroid, and 9 cases with various histological type. All patients underwent posterior open surgery assisted with radiofrequency ablation. Results: The mean blood loss was 1083±1193ml(range, 250-5400ml), complications included 3 cases of CSF leak, 2 cases of asymptomatic bone cement leakage, 1 case of epidural hematoma and 1 case of wound infection. All were healed after surgical or non-surgical treatment. The mean visual analog score(VAS) before surgery was 4.3, which dropped to 1.3 at one month after surgery(P＜0.05), 26 out of 30 patients(86.7%) received pain relief, and an improved or a stable neural function was presented in all 30 patients. The mean follow-up time was 10±8 months, during which all patients except three were free of local tumor recurrence. Conclusions: With less surgical trauma, RFA assisted open surgery is able to serve as a palliative approach to achieve low complication rate, relieved pain, improved neural functions and satisfying local tumor control.