脊柱转移瘤外科治疗的临床分析

Clinical analysis of surgical treatment in spinal metastases

目的：探讨脊柱转移瘤手术治疗的疗效。方法：回顾性分析1991—06～2005—06收治的59例脊柱转移瘤患者的临床资料，其中手术患者27例，包括脊柱肿瘤全部、部分切除及脊柱重建术。非手术组32例，接受化疗或放疗治疗。结果：手术组术后2周自我疼痛评价，疼痛基本消失16例（59．3％），疼痛减轻9例（33.4％），疼痛未缓解2例（7．3％）。无手术中、手术期死亡以及瘫痪等并发症发生，生存期1、43～34个月，中位生存期10个月。未手术组患者疼痛基本消失5例（15.6％），疼痛减轻17例（53．1％），疼痛未缓解10例（31．3％），生存期1．20～20个月，中位生存期6个月。疼痛的缓解率两组比较，差异有统计学意义，χ^2=4．37，P=0．036。生存率两组比较，差异有统计学意义，χ^2=6．16，P〈0．05。结论：脊柱转移瘤患者应尽早争取手术治疗，减轻神经压迫症状体征，延长生存时间。

OBJECTIVE： To investigate the efficacy of surgical treatment in spinal metastases. METHODS, A retrospective analysis of clinical data from June 1991 to June 2005 was performed in 59 patients with spinal metastases. Twenty-seven of the 59 patients were treated with surgery, including total or partial tumor removal and spinal reconstruction. Thirty-two were treated with chemotherapy or radiotherapy. RESULTS： In the surgical group, the sel-rated pain was relieved in 16 （59.3%） patients, reduced in 9 （33.4%） patients, and without changes in 2 （7.3%） patients. There were no such complica tions as death or paralysis during or shortly after the surgery, The survival time was from 1.43 to 34 months, and the median survival time was 10 months. In the non surgical group, the self-rated pain was relieved in 5 （15.6%） patients, reduced in 17 （53. 1%） patients, and without changes in 10 （31.3%） patients. The survival time was from 1.2 to 20 months, and the median survival time was 6 months. The difference of pain relief rates between the two groups was statistically sig nificant （χ^2=4.37, P=0, 036）. The difference of survival rates between the two groups was also statistically significant （χ^2= 6, 16, P〈0.05）, CONCLUSION： Patients with spinal metastases should receive surgical treatment as soon as possible in order to alleviate their symptoms and signs of nerve compression, and to extend their survival time.