不同方法治疗椎体转移瘤的对比研究

The contrast study of vetebral metastasis treatment with different ways

目的：研究椎体转移瘤不同治疗方法的疗效和安全性。方法：对符合入组条件的187例患者采取不同的治疗方法,包括放疗52例,总剂量为30Gy,分10次2周完成;经皮椎体成形术（percutaneous vertebroplasty,PVP）治疗50例,骨水泥（PMMA）的粉液比例为1：1～1：4,用量为2～10ml;^125I粒子植入治疗36例,植入10～25颗125I粒子,活度为0.5～0.8mCi/颗,籽源间距为0.6～1cm;PVP和^125I粒子植入术结合（简称联合组）治疗49例,PMMA用量为2～6ml,植入10～20颗^125I粒子。除放疗外,均采用CT引导,单侧或双侧椎弓根及椎体侧旁进针。结果：所有患者均按计划完成治疗,治疗后1d、1M、3M、6M时,联合组疼痛完全缓解和显著缓解率最高,分别达到89.8%、87.7%、95.9%、93.9%;联合组治疗部位椎体塌陷加重或发生新的压缩性骨折率最低,6个月时为4.1%,无严重并发症发生。结论：不同类型的椎体转移瘤应采取不同的治疗方法,虽然不同的治疗方法具有不同的特点,但PVP和^125I粒子植入术结合治疗椎体转移瘤,在疼痛缓解和预防椎体塌陷加重或发生新的压缩骨折方面疗效显著,能提高生存率,无明显并发症。

Objective：To investigate the curative effect and the security with the different ways in the treatment of vertebral metastasis.Methods：187 cases had been treated by different ways,i.e,52 cases had been irradiation by the dosage of 30Gy/10f/2w;50 cases had been cured by 2～10ml PMMA;36 cases had been cured by embedment of ^125 I by CT guide,the number of ^125 I particles was 10～25,the radioactivity quantum were 0.5～0.8mCi per granule.49 cases had been cured by 2～6 ml PMMA and 10～20 ^125 I particles.With the exception of those irradiated cases,all of the cases had been done by CT guidance via the passage of the unilateral or double vertebral root and the para vertebra.Results：All of the cases had been treaed according to the plan.The rates of ache relief entirly or partly were 89.7%,87.7%,95.9%,93.9% respectively,after cured 1d,1M,3M,6M by PMMA and embedment of ^125 I,and the rate of fracture after 6M was 4.1%.There was no complication.Conclusion：Different ways should be used for different vertebral metastasis.Although there were different characteristic,by different ways,it had significant effect on the ache relief entirly or partly and the fracture,the rate of existence in vertebral metastasis treatment with PMMA and embedment of ^125 I,further more,there was no serious complication.