微波诱导高温原位灭活治疗脊柱恶性肿瘤的临床初步观察

A primary report of hyperthermia inactivation induced by microwave in treating malignant tumor in the spine

目的探讨应用微波诱导高温原位灭活治疗脊柱恶性肿瘤的效果。方法12例脊柱恶性肿瘤患者,其中原发恶性肿瘤4例、转移性肿瘤8例。单一椎体11例,相邻两个椎体1例。术中先行双侧椎板开窗或切除,经椎弓根插入2根微波天线,诱导高温灭活15～30min,灭活温度50℃～85℃,灭活过程中硬膜外冰水降温。结果1例术后24h出现单侧下肢感觉、运动功能完全消失,3周后逐渐恢复,余无任何围手术期并发症。手术出血量300～850ml,平均550ml;手术时间1.5～3.5h,平均2.5h。术后随访3个月～1年,Frankel神经功能分级较术前改善,1例转移瘤患者死亡,1例局部复发。结论微波诱导高温原位灭活脊柱肿瘤具有手术出血少、缩短手术时间等优点,远期效果有待进一步随访观察。

Objective To evaluate the devitalizing effect of hyperthermia induced by microwave in treating malignant tumor in the spine. Methods Twelve patients with malignant tumor in the spine were selected, Four patients sustained primary malignant tumor, and eight sustained metastastic tumors. Eleven patients had single vertebra involvement and the another had two vertebral involvement. After bilateral laminectomy, 2 microwave antennae were inserted into the vertebrae through the pedicle to induce hyperthermia inactivation for 15 to 30 minutes. The inactivation temperature ranged from 50℃ to 85℃. During this process, the dura mater was cooled with cold 0.9% Nacl solution from the outside to protect the spinal cord and nerves. Results Unilateral sensory deprivation and motion functional incapacitation in the lower limb occurred in one patient 24 hours after surgery. The patient recovered gradually in 3 weeks without any complication. The blood loss ranged from 300 ml to 850 ml, with an average of 550 ml; the operation time ranged from 1.5 to 3.5 hours, with an average of 2.5 hours. All patients were followed up from 3 through 12 months. The Frankel neurological function gradation has been improved after surgery. One patient died of metastasis and another had local recurrence. Conclusion This treatment brings less blood loss and costs shorter operation time. Further study of the follow-up is needed to evaluate the long-term effect.