原发灶不明脊柱转移癌的诊断和手术治疗

The diagnosis and surgical intervention of spinal metastasis of unknown origin

目的 探讨原发灶不明脊柱转移癌的诊断和手术治疗的临床疗效。方法 对 4 6例原发灶不明脊柱转移癌进行回顾性分析 ,其中手术为主的综合治疗 2 4例 ,非手术治疗 2 2例。结果 随访 1～ 4年 ,手术患者 1年存活率 2 2 7% (5例 ) ,3年存活率 9 1% (2例 ) ,4年内全部死亡 ,平均生存期为 6 2个月。疼痛消失或缓解2 0例 ;6例不全瘫痪患者 ,术后神经功能 1例完全恢复 ,2例部分恢复 ,3例无改变 ;完全瘫痪者则无一例恢复 ;14例无瘫痪患者术后 3例发生截瘫 ,较同期无瘫痪未手术者的截瘫发生率低。结论 原发灶不明脊柱转移癌预后差 ,手术为主的综合治疗能减轻或缓解疼痛、维持或改善神经功能、稳定脊柱 ,减少截瘫的发生 。

Objective To study the diagnosis and surgical intervention clinical outcomes of spinal metastasis of unknown origin. Methods 46 cases of spinal metastasis of unknown origin were analysed retrospectively. 24 cases were treated by surgical intervention and the others by non-surgical intervention. Results 41 cases were followed up for 1～4 years, of which 22 cases were treated by surgical intervention, the one-year survival rate was 22.7%(5 cases), the three-year was 9.1%(2 cases), and all the patients died within 4 years. The average survival period was 6.2 months. Pain relief was obtained in 20 of 22 patients, and 1 got complete neurological function recovery, 2 partial recovery,and 3 no improvement in 6 cases with incomplete paraplegia.2 cases with complete paraplegia got no recovery. 3 of 14 cases without paralysis treated by surgical intervention were developing paraplegia during follow-up, the occurrence rate of paraplegia was lower than that of without paralysis treated by non-surgical intervention. Conclusion Surgical intervention could stabilize and reconstruct the spine, relieve pain, prevent paraplegia, maintain or improve the neurological status of the patients, thus improve the life qualities in limited life expectancy patients.