改良经皮椎体后凸成形术在胸腰椎转移癌诊断和治疗中的应用

IMPROVED PERCUTANEOUS KYPHOPLASTY FOR DIAGNOSIS AND TREATMENT OF THORACOLUMBAR METASTATIC SPINE TUMORS

目的探讨改良经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)对无法耐受开放手术及麻醉的胸腰椎转移癌患者的诊断和治疗价值。方法 2009年9月-2010年9月,采用改良PKP治疗无法耐受开放手术及麻醉的胸腰椎转移癌16例。男7例,女9例;年龄60～73岁,平均64.5岁。病程3～6个月,平均4个月。均为胸腰椎转移癌。腰背疼痛采用视觉模拟评分(VAS)为(8.9±0.8)分,均无脊髓及神经根受压表现。受累椎体:T7 1例,T8 1例,T12 1例,L2 2例,L3 2例,L4 3例,T1、2 1例,T3、4 1例,T7、8 1例,T11、12 1例,T7～L1 1例,T12～L4 1例。椎体后壁均完整,椎体压缩性骨折9例,椎体压缩程度均<75%。结果患者均顺利完成手术,无严重心、肺、脑血管不良反应和围手术期内死亡。病理检查均确诊为转移性腺癌。患者均获随访,随访时间9～18个月,平均14个月。术后6个月疼痛按WHO标准分度,14例(87.5%)完全缓解,2例部分缓解。术后6个月VAS评分降至(1.8±0.6)分,与术前比较差异有统计学意义(P<0.05)。术后6个月CT检查示,2例3个椎体存在不同程度骨水泥渗漏。随访期间12例死亡,其余带瘤生存,腰背疼痛症状明显缓解。结论对于无法耐受开放手术及麻醉的胸腰椎转移癌患者,采用改良PKP进行诊断和治疗具有创伤小、活检准确率高,疼痛缓解迅速,且能提高患者生存质量,是一种良好的姑息治疗方法。

Objective To investigate the diagnosis and effectiveness of improved percutaneous kyphoplasty（PKP） for patients with thoracolumbar metastatic tumors,who could not tolerate anesthesia and open operation.Methods Between September 2009 and September 2010,16 patients with thoracolumbar metastatic tumors underwent improved PKP.Of 16 patients,7 were male and 9 were female with an average age of 64.5 years（range,60-73 years）.All patients had vertebral metastasis tumor.The disease duration was 3-6 months with an average of 4 months.The visual analogue scale（VAS） score was 8.9 ± 0.8.No spinal cord compression and nerve root compression was observed.The involved vertebrae included T7 in 1 case,T8 in 1,T12 in 1,L2 in 2,L3 in 2,L4 in 3,T1,2 in 1,T3,4 in 1,T7,8 in 1,T11,12 in 1,T7-L1 in 1,and T12-L4 in 1.Nine patients had vertebral compression fracture with a vertebral compression rate below 75%.Results All patients were successfully performed PKP.There was no serious adverse reactions in cardiopulmonary and brain vascular systems and no perioperative death.The biopsy results showed that all were metastatic adenocarcinoma.All patients were followed up 9-18 months（mean,14 months）.Complete pain relief was achieved in 14 cases and partial relief in 2 cases 6 months after operation according to World Health Organization criterion,with a pain-relief rate of 87.5%.The VAS score was 1.8 ± 0.6 at 6 months postoperatively,showing significant difference when compared with the preoperative score（P 0.05）.Two patients had cement leakages in 3 vertebrae with no symptoms at 6 months postoperatively.During follow-up,12 patients died and the others survived with tumor.Conclusion For patients with thoracolumbar metastatic tumors who can not tolerate anesthesia and open operation,improved PKP has the advantages such as minimal invasion,high diagnostic rate,and early improvement of pain in the biopsy and treatment.It can improve patient’s quality of life in the combination of radiotherapy or chemotherapy.