脊柱转移性肿瘤外科治疗生存质量分析

Life Quality Assessment in Patient with Spinal Metastases Managed by Surgical Intervention

【目的】对脊柱转移性肿瘤患者手术前后的生存质量指标进行评估,评价外科治疗的价值。【方法】23例患者,男性12例,女性11例,平均年龄60岁。对接受手术治疗的23例脊柱转移性肿瘤患者手术前后的疼痛程度、食欲、睡眠、不良情绪、体力状况以及神经脊髓功能等指标进行前瞻性观察、比较和综合评价。【结果】颈椎转移瘤3例,胸椎转移瘤12例,腰椎转移瘤8例。除1例术后出现肺功能衰竭死亡,其余患者无其他严重围手术期并发症。患者术后2周、1个月、3个月的疼痛程度、食欲、睡眠质量、不良情绪、神经功能等均较术前明显改善,以疼痛改善最为显著,体力状况也于术后1个月、3个月较术前改善。术后患者平均生存期8.7个月,术后1年存活率为27%。【结论】外科治疗能显著改善脊柱转移性肿瘤患者的生存质量。对于能够耐受手术、估计生存期超过3个月的脊柱转移性肿瘤患者,转移瘤椎体切除重建的外科干预是值得推荐的治疗手段。

[Objective] To prospectively evaluate the efficacy of surgery in the patients with spinal metastases with respect to life quality. [Methods] Twenty-three consecutive patients undergoing surgieal intervention for spinal metastases were prospectively evaluated. Assessments were performed with respect to pain, appetite, sleeping quality, unhealthy emotion, performance status and neural function. [ Results] Twenty-three cases of patients were involved in this group which included 12 males and 11 females, the average age was 60 years. There were 3 metastases occurred in cervical spine, 12 in thoracic and 8 in lumbar spine. Except the early death of one patient because of respiratory failure, there were no other severe complications during perioperative period. Significant improvements were observed in the remained cases in the aspects of pain, appetite, sleeping quality, unhealthy emotion, and neural function by the time of 2 weeks, 1 and 3 months postoperatively. Performance status in most of the patients was also improved at 1 and 3 months after surgical intervention. The mean survival time was 8.7 months and the 1-year survival rate was 27% postoperatively. [ Conclusions ] Surgical intervention can bring about a positive effect on the overall quality of life in the appropriate patients with spinal metastases. According to current study, surgery is recommended if the expected survival of the patient is more than 3 months.