病灶内边界整块切除对于恶性和局部侵袭性脊椎肿瘤的意义

The role of intralesional margin en bloc resection in malignant and local aggressive spinal neoplasms

中文关键词:  脊椎  肿瘤  整块切除  分块切刮  外科边界

英文关键词:Vertebrae  Neoplasm  En bloc resection  Piecemeal resection  Surgical margin

中文摘要:

  【摘要】 目的：对比病灶内边界整块切除与分块切刮治疗恶性或局部侵袭性脊椎肿瘤患者的预后，评估肿瘤不同切除方式对临床疗效的影响。方法：2007年6月～2015年12月47例计划进行整块切除的脊柱原发性肿瘤或孤立性转移瘤患者（获得病灶内边界），按照肿瘤切除方式分为整块切除和分块切刮两组。其中32例患者进入整块切除组，15例未能完成肿瘤整块切除的患者进入分块切刮组。对两组患者的年龄、性别、肿瘤恶性程度、累及部位、手术入路、是否全脊椎切除、随访时间、术中出血量、手术时间、肿瘤局部复发、生存情况、并发症情况进行统计比较。结果：两组患者在平均年龄、性别、肿瘤恶性程度、累及节段、手术入路、是否全脊椎切除、术后神经功能改善、随访时间等方面无显著性差异（P＞0.05）。平均手术时间整块切除组424.53±236.93min，分块切刮组306.67±90.92min（P＜0.05）；平均术中出血量整块切除组4043.75±2305.80ml，分块切刮组3680.00±3163.23ml（P＜0.05）。整块切除组和分块切刮组中，分别有11例（34.4%）和3例（20%）患者出现并发症（P＜0.05）。整块切除组肿瘤局部复发12例（37.5%），随访期内17例无瘤生存，8例带瘤生存，7例因肿瘤死亡；分块切刮组肿瘤局部复发9例（60%），无瘤生存，带瘤生存，因肿瘤死亡各5例。两组在肿瘤局部无复发生存率及总体生存率上存在显著差异（P＜0.05）。结论：对脊柱恶性或侵袭性肿瘤进行整块切除，即使获得病灶内边界，较分块切刮仍具有较好的局部控制和生存率，但具有较高的并发症发生率。

英文摘要:

  【Abstract】 Objectives: To observe the spinal tumor local control and survival rate and its complications in patients with malignant and invasive tumor and undergoing intralesional margin en bloc resection. Methods: 47 patients with primary or solitary metastatic spinal tumors receiving intralesional margin en bloc resection were included in this study. The patients were divided into two groups according to en bloc or piecemeal resections. There were 32 patients and 15 patients in two groups, respectively. Factors included age, gender, tumor malignancy, involved spinal levels, surgical approaches, receiving total spondylectomy or not, follow-up time, blood loss volume, operation time, tumor local recurrence, survive, and complications were compared between two groups. Results: The difference was not significant(P＞0.05) between two groups with regard to age, gender, tumor malignancy, involved spinal levels, surgical approaches, receiving total spondylectomy or not, improvement of postoperative neurological function or follow-up time. Patients with en bloc resection had longer average operation time(424.53±236.93min vs 306.67±90.92min) and more blood loss volume(4043.75±2305.80ml vs 3680.00±3163.23ml) than patients with piecemeal resection(P＜0.05). Complications were noted in 11 patients(34.4%) and 3 patients(20%) in group of en bloc resection and group of piecemeal resection, respectively. In group of en bloc resection, 12 patients (37.5%) had local recurrence, 17 patients survived with no evidence of disease, 8 patients lived with disease, and 7 patients died of disease at the end of follow-up. In group of piecemeal resection, local recurrence occurred in 9 patients (60%), and 5 patients survived with no evidence of disease, 5 were alive with disease, and 5 died of disease, respectively. The differences on local recurrence free survival rate and overall survival rate between two groups were significant(P<0.05). Conclusions: En bloc resection for patients with malignant or invasive spinal tumors has better local tumor control, higher survival rate and complication rate than patients with piecemeal resection, even with intralesional margin.