杂交分离手术治疗伴有脊髓压迫症状的胸腰椎转移瘤的疗效观察

Observation on the curative effect of hybrid separation surgery for the treatment of thoracic and lumbar vertebra metastasis with spinal cord compression symptoms

中文关键词:  脊柱转移性肿瘤  杂交分离手术  脊髓压迫  临床疗效

英文关键词:Spinal metastasis  Hybrid separation surgery  Spinal cord compression  Clinical effect

中文摘要:

  【摘要】 目的：评估杂交分离手术治疗伴有脊髓压迫症状的胸腰椎转移瘤的临床疗效。方法：回顾性分析2013年6月~2018年6月我院收治的28例因伴有脊髓压迫症状的胸腰椎转移瘤行手术治疗患者的临床资料，其中男18例，女10例，年龄57.0±10.8岁（41～77岁）。原发肿瘤类型：肺腺癌12例，肺鳞癌2例，肺神经内分泌癌1例，直肠腺癌6例，肾透明细胞癌3例，乳腺癌2例，肝细胞癌1例，前列腺癌1例。肿瘤侵犯脊柱部位：单发胸椎转移13例、腰椎转移11例，多发胸椎转移2例、腰椎转移1例，胸腰椎转移1例。术前Frankel分级A级1例，B级5例，C级6例，D级16例；疼痛视觉模拟评分（visual analogue scale，VAS）为7.3±0.8分；Tomita评分5.9±0.9分（4～7分）；硬膜外脊髓压迫（epidural spinal cord compression，ESCC）评分1b级3例，1c级9例，2级8例，3级8例。均行杂交分离手术，具体方法包括后入路椎体肿瘤部分切除减压、骨水泥钛网支撑、骨水泥填充封闭、椎弓根螺钉内固定术。统计手术时间、术中出血量、术后住院天数，术后即刻及术后3个月时的Frankel分级，术后7d及术后3个月时的VAS评分，美国东部肿瘤协作组（Eastern Cooperative Oncology Group，ECOG）体力状况评分，术中和术后相关并发症情况以及患者生存期。结果：手术时间为202.0±34.7min（140～285min），术中出血量为819.6±150.0ml（500～1100ml），术后住院日为13.2±3.9d（7～22d）。术中及术后并发症：脑脊液漏3例，切口感染3例，尿路感染1例，肺部感染1例，术后急性神经根刺激症状3例，随访至12个月时发生钛网移位1例。术后7d、3个月VAS评分及ECOG评分与术前比较均有显著性改善（P＜0.05）。中位随访时间为20.5个月（6～42个月），平均随访时间为21.3±10.0个月，至末次随访有6例存活，其中1例于术后30个月时出现椎体新发转移，行二次手术后仍带瘤生存，至末次随访时存活时间为38个月。结论：杂交分离手术治疗伴有脊髓压迫症状的胸腰椎转移瘤能够明显减轻脊髓压迫，改善患者神经功能，缓解疼痛，提高生活质量。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical efficacy of hybrid separation surgery in the treatment of thoracic and lumbar vertebra metastasis with spinal cord compression symptoms. Methods: Retrospective analysis was performed on the clinical data of 28 patients with thoracolumbar metastatic tumors associated with spinal cord compression that underwent surgical treatment. They were admitted to our hospital from June 2013 to June 2018. There were 18 males and 10 females with an average age of 57.0±10.8 years(41-77 years). According to the primary tumor types: 12 cases were of lung adenocarcinoma, 2 of lung squamous cell carcinoma, 1 of pulmonary neuroendocrine carcinoma, 6 of rectal adenocarcinoma, 3 of renal clear cell carcinoma, 2 of breast cancer, 1 of hepatocellular carcinoma, and 1 of prostate cancer. According to the site of the tumor in spine: 13 cases were of single thoracic vertebral metastasis, 11 of single lumbar spine metastasis, 2 of multiple thoracic vertebral metastasis, 1 of multiple lumbar vertebra metastasis, and 1 of thoracolumbar spine metastasis. Preoperative Frankel grade: 1 case was grade A, 5 cases were grade B, 6 cases were grade C, and 16 cases were grade D; Visual analogue scale(VAS) score was 7.3±0.8, Tomita score was 5.9±0.9 (4-7); Preoperative epidural spinal cord compression(ESCC) grade 1b score was in 3 cases, 9 cases were of grade 1c, 8 cases were of grade 2, and 8 cases were of grade 3. All patients underwent hybrid separation surgery. The specific methods include posterior approach partial decompression of vertebral tumor, bone cement titanium mesh support, bone cement filling and sealing, and pedicle screw fixation. The operation time, intraoperative blood loss, postoperative hospitalization days, Frankel gradings immediately after surgery and 3 months postoperatively, the VAS scores and the Eastern Cooperative Oncology Group(ECOG) physical status scores at 7 days and 3 months after surgery, intraoperative and postoperative complications, and survival time of the patients were collected for statistics. Results: The average operative time was 202.0±34.7min (140-285min), the average intraoperative blood loss was 819.6±150.0ml(500-1100ml), and the average postoperative hospital stay was 13.2±3.9 days(7-22 days). Intraoperative and postoperative complications: cerebrospinal fluid leakage in 3 cases, incision infection in 3 cases, urinary tract infection in 1 case, pulmonary infection in 1 case, postoperative acute nerve root stimulation in 3 cases, and titanium mesh displacement in 1 case at 12 months follow-up. The VAS scores and ECOG scores at 7 days and 3 months after operation were significantly improved compared with those before operation(P<0.05). The median follow-up time of the patients in this group was 20.5 months(6-42 months), and the mean follow-up time was 21.3±10.0 months. There were 6 patients alive at the last follow-up. Among them, 1 patient had new metastasis at 30 months after the operation, and the patient was alive with tumor after a second operation, with the survival time at the last follow-up of 38 months. Conclusions: Hybrid separation surgery for thoracolumbar metastatic tumors with spinal cord compression symptoms can significantly relieve spinal cord compression, improve neurological function, relieve pain, and improve the quality of life.