脊柱恶性肿瘤的综合治疗策略临床分析

Clinical Analysis of the Strategies of Comprehensive Treatment for Spinal Malignant Tumors

目的 探讨脊柱恶性肿瘤综合治疗策略的临床意义及预后.方法 2003年1月～2008年12月收治脊柱原发恶性肿瘤及原发病灶隐匿的转移瘤患者25例,对其临床特点、术前穿刺取病理活检、术前半程放疗、手术方式、术后放化疗等综合治疗策略及预后进行分析.观察随访手术时间、术中出血量、局部疼痛和脊髓功能的恢复情况,以及肿瘤的复发、植骨融合、脊柱稳定性情况.结果 25例患者均顺利完成手术,手术时间120～300min,术中出血500～3200ml,平均1500ml.术后随访6个月～5年,所有患者近期疗效满意,局部疼痛及神经系统症状均有不同程度的缓解或改善.末次随访存活病例植骨融合良好,无内固定松动、移位、断裂及脊柱失稳情况,无局部复发.术后6个月、1、2、3、4年的生存率分别为100%,96.00%,84.00%,76.00%,68.20%.结论 对于脊柱原发恶性肿瘤及原发病灶隐匿的转移瘤进行合理有效、及时的综合治疗,能够稳定和重建脊柱,减轻或缓解疼痛,维持或改善神经功能,从而改善患者的生活质量,延长生存期.

Objective To study the clinical features and the prognosis of patients with malignant tumors in spine. Methods From Jan. 2003 to Dec. 2008,25 cases with primary malignant tumors or metastatic tumors in the spine were treated by comprehensive treatment, including percutaneous pathologic examine, half period of radiation treatment before operation, surgical methods and postoperative chemotherapy etc. The methods of the comprehensive treatment and the prognosis were analysed and summarized. The operation duration, blood loss ,local pain, as well as tumor recurrence, status of bony fusion and stability were follow-up and reviewed. Results All patients experienced operations successfully. The operation time ranged from 120 to 300 minutes and blood loss volume ranged from 500 to 3200ml,the average volume of the blood loss was 1500ml. The follow-up period was 6 months to 5 years. The clinical results showed satisfactory early outcome with relieve of local pain and improvement or maintenance of neurological status caused by spinal cord compression. The living patients at final follow-up were found with good bony fusion and no incidence of instrument failure and local recurrence. The postoperative 6-month, one-year, two-year,three-year and four-year survival rates were 100% ,96.00% ,84.00% ,76.00% ,68.20%. Conclusion For patients with primary malignant tumors or metastatic tumors in the spine,the comprehensive treatment are reasonable,effective and in time,it could stabilize and reconstruct the spine,relieve pain,maintain or improve the neurological status of the patients,thus.improve the life qualities and prolong survival time of patients with limited life expectancy.