胸腰椎转移瘤98例的手术治疗

Surgical Treatment of 98 cases of thoracolumbar metastases

目的探讨胸腰椎转移瘤手术治疗的适应证、手术方法及疗效。方法从1994年1月～2003年1月收治的 169例胸腰椎转移瘤中,选择瘤椎仅限于1～2节段,行瘤椎切除并内固定116例,获得随访结果者98例,男性58例,女性 40例,年龄21～78岁,平均56．5岁。胸椎63例,腰椎35例。椎体84例,椎弓14例。单节段92例,双节段6例。原发瘤包括转移性腺癌17例,转移性鳞癌16例,肺癌11例,乳腺癌11例,低分化转移癌8例,肾癌6例,胃肠癌6例,前列腺癌5 例,食道癌4例,肝癌4例,甲状腺癌3例,胆道癌3例,子宫癌2例,鼻咽癌与卵巢癌各1例。重度疼痛69例,中度疼痛23 例,合并截瘫39例。肿瘤椎体切除 Luque 棒加骨水泥椎体成形43例,肿瘤椎体切除钢板螺钉固定加骨水泥成形41例,椎弓肿瘤切除 Luque 环与椎板下节段钢丝固定14例。结果随访8个月～4年,平均2．5年,疼痛缓解80/92例。39例截瘫中完全恢复10例,部分恢复23例,不恢复6例,截瘫改善率84．6%(33/39例)。生存期内胸腰椎稳定性良好,内固定无松动移位和折断。最短生存5个月,最长生存3．5年,生存期超过2年者17．3%(17/98例)。结论手术能切除顽固的瘤灶,脊髓减压和稳定脊柱,从而缓解疼痛,维护或改善神经功能,提高生存质量。

Objective To study the indication and methods effect of patients with the metastatic tumors in the thoracolumbar of surgical treatment and the clinical spine. Methods The study presented a retrospective analysis of 98 patients with thoracolumbar metastases from Jan. 1994 to Jan. 2003.In the groW, there were 58males and 40females ,aging from 21-78years old with the mean age of 56.5 years. 39 cases had neurological deficit Among 84 cases with metastases of vertebral body, 43 cases were reconotructed with Luque rod and bone cement, 41 with palte and bone cement, after resection of tumors. Fortecn cases with vertebral arch metasteses were fixed with Luque ring and segmental wires after resection of tumors. Results The period of follow-up from 8 months to 4 years with a mean of 2.5 years. 98 patients were followed-up. The postoperative survival time over two years were 17 cases （17/98）. The pain was relieved in 80/92 cases. Among 39 cases with meurological deficit 10 had copmplete recovery, 23 partial recovery and 6 no improvement. Thoracolumbar spinal stability was good. Internal fixateor without loosening and breakage. Conclusions Surgical intervention can stabilize and reconstruct the spine,relieve pain, maintain or improve the neurological status of the patients, thus improve the life qualities of patients.