脊柱转移瘤手术治疗的生活质量随访

Quality of life in surgical treatment of spinal metastases

目的从生活质量及肿瘤学预后方面探讨外科手术对脊柱转移瘤的治疗价值。方法 2004年3月～2009年1月,对36例行前路或后路减压内固定术的脊柱转移瘤患者进行随访,手术前后的生活质量应用埃德蒙顿症状评估量表(Edmonto symptom assessment scale,ESAS)进行评定。结果截至2009年7月的末次随访,所有病例存活6～36个月(8例末次随访时尚存活),平均存活15.2个月。68%的患者神经功能明显改善。得到成功评估的30例患者生活质量总评分有显著改善,其中最明显的改善是疼痛,其余依次为幸福感、疲惫感、食欲、焦虑、恶心及思睡,而在情绪低落及气紧方面没有显著变化。结论对于单发的、原发瘤恶性程度相对较低的及Tokuhashi修正评分为12～15分的患者进行积极的外科治疗能明显改善其生活质量及术后功能,其中改善最显著的是疼痛。

Objective To evaluate the efficacy of surgery in patients with spinal metastases with respect to quality of life and oncology prognosis.Methods From March 2004 to January 2009,36 consecutive patients underwent anterior or posterior decompression and internal fixation for spinal metastases were evaluated.Pre-and postoperative quality of life of the patients were evaluated with the Edmonton symptom assessment scale（ESAS）.Results All patients survived 6-36 months until the final follow-up（July 2009）,the average survival time was 15.2 months with 8 patients still alive at the final follow-up.The neurological function was obviously improved in 68% cases.After surgery,the total score of the ESAS significantly improved in 30 successfully evaluated patients,and the largest improvement was noted in the domain of pain.There were also significant improvements noted in the domains of well-being,tiredness,appetite,anxiety,nausea and drowsiness.But no obvious changes in terms of depression and shortness of breath.Conclusion For patients with solitary spinal metastasis,low-malignant primary tumor and the Tokuhashi revised score of 12-15 points,surgical management brings about a positive effect on the overall quality of life,and the greatest benefit occurrs in the pain reduction.