经皮椎体成形术治疗椎体转移性肿瘤的疗效分析

Percutaneous vertebroplasty for the treatment of spinal metastasis:evaluation of the therapeutic efficacy

目的探讨经皮椎体成形术(PVP)治疗椎体转移性肿瘤的疗效及其影响因素。方法入住南京东南大学附属中大医院椎体转移性肿瘤患者163例266节椎体采用PVP治疗且随访资料完整,原发癌肿主要为肺癌(42例),肝癌(19例),食管及胃肠癌(34例),肾癌(10例),乳腺癌(46例)等。PVP术后3dCT复查观察骨水泥分布状况及有无渗漏。按PVP术后24h,1周,1、3、6和1年以上定期随访评价临床疗效、疼痛复发的原因及观察生存时间。结果 266节椎体PVP操作均成功,138节胸椎骨水泥平均注入量为(3.6±1.5)ml,128节腰椎为(4.5±1.7)ml。平均随访时间(12.0±10.6)个月,术后24h,1周,1、3、6和12个月有效率分别为87.7%(143/163)、92.6%(151/163)、91.4%(149/163)、84.5%(136/161)、78.3%(108/138)和77.2%(71/92)。术后12个月症状复发39例,复发率23.9%(39/163),包括骨水泥周围癌肿进展6例,其他椎体转移33例。平均生存时间(10.5±10.5)个月,其中乳腺癌与前列腺癌椎体转移54例生存时间为(15.4±11.7)个月,明显长于肺癌、肝癌、胃肠癌及肾癌等105例的生存时间[(8.5±8.1)个月](P<0.05)。随访期间死亡136例,主要死亡原因为脊椎外原发肿瘤进展及全身多发转移衰竭。CT证实椎旁骨水泥渗漏58例,均无临床症状。结论 PVP治疗椎体转移性肿瘤可迅速缓解疼痛且可保持较长时间稳定;疼痛复发的主要原因是其他椎体新发转移;生存时间与椎体外原发癌肿类型和合并内脏转移密切相关。

Objective To discuss the efficacy of percutaneous vertebroplasty（PVP） for the treatment of vertebral metastases,and to analyze the factors influencing the efficacy.Methods At our institution PVP was performed in 163 consecutive patients with vertebral metastasis.A total of 266 vertebral lesions were detected.All the patients had complete medical records.The clinical data were retrospectively analyzed.The primary carcinomas included lung cancer（n = 42）,hepatic carcinoma（n = 19）,esophageal and gastrointestinal cancer（n = 34）,renal cancer（n = 10）,mammary cancer（n = 46）,prostate cancer（n = 8）,lymphoma（n = 2）,nasopharyngeal carcinoma（n = 1） and ureteral cancer（n = 1）.CT scanning was performed within 3 days after PVP to observe the distribution of bone cement（polymethylmethacrylate,PMMA） within the vertebrae and to determine whether there was any cement leakage or not.The patients were followed up periodically at the time of 24 hours,one week,one,3,6 and 12 months after PVP.The clinical condition,the recurrence of back pain and the survival time were observed,and the therapeutic results were evaluated.Results Technical success was achieved in all 266 diseased vertebrae.The mean injected amount of PMMA was（3.57 ± 1.50） ml for thoracic vertebrae and（4.53 ± 1.72） ml for lumbar vertebrae.The mean follow-up time was（12.0 ± 10.6） months.The pain remission rate at 24 hours,one week,1,3,6 and over 12 months after PVP was 87.7%（143 /163）,92.6%（151 /163）,91.4%（149 /163）,84.5%（136 /161）,78.3%（108 /138） and 77.2%（71 /92）,respectively.Twelve months after PVP recurrent back pain developed in 39 patients,with a recurrence of 23.9%（39 /163）.Of these 39 patients,cancerous infiltration around bone cement was seen in 6 and new vertebral metastases in 33.The average survival time of 163 patients was（10.48 ± 10.47） months.The survival time in 54 patients with breast or prostate cancer was（15.4 ± 11.7） months,which was significantly longer than that in 105 patients with lung,liver,gastrointestinal or kidney cancer（8.5 ± 8.1 months,P 0.05）.During the following-up period 136 patients died.The main cause of death was the deterioration of primary cancer and multi-systemic failure due to metastases.Fifty-eight patients showed paravertebral bone cement leakage on CT scans,but clinically they were asymptomatic.Conclusion PVP is an effective and safe procedure for treating symptomatic vertebral metastases.It can rapidly relieve the pain and keep the vertebral condition stable for long time.The recurrence of back pain is mainly caused by newly-developed vertebral metastasis.Patient＇s survival time is closely related to the pathologic behavior of the primary cancer and co-existing visceral metastases.