血管内化疗栓塞术联合椎体成形术治疗椎体转移性肿瘤的临床应用分析

Intravascular chemoembolization combined with percutaneous vertebroplasty for the treatment of metastatic vertebral tumors: an analysis of its clinical application

目的探讨血管内化疗栓塞术和经皮椎体成形术(PVP)联合治疗椎体转移性肿瘤的临床疗效。方法采用血管内化疗栓塞术及PVP联合治疗25例(共32节椎体)椎体转移性肿瘤患者,随访并分析其疼痛症状缓解情况。结果所有患者均成功行椎体肿瘤供血动脉化疗栓塞术及PVP,其中有15例患者行碘化油+吡柔比星乳剂化疗栓塞,所用碘化油平均1.8 ml[(1.4±1.0)ml],吡柔比星10 mg,其余10例行吡柔比星10 mg灌注化疗后采用明胶海绵颗粒栓塞。25例患者行椎体肿瘤血管化疗栓塞后1周内20例患者疼痛症状有所缓解(缓解率80%),1周内所有患者均接受PVP,手术均获得成功,其中8例患者各1节椎体行双侧穿刺,其余均为单侧穿刺,技术成功率100%。11节胸椎骨水泥平均注入量为(3.3±1.6)ml,21节腰椎为(4.2±1.5)ml,术后平均生存时间(10.0±5.6)个月,PVP术后24 h,1周及1、3、6和12个月有效率分别为100%(25/25)、96%(24/25)、84%(21/25)、82.6%(19/23)、78.9%(15/19)和69.2%(9/13)。结论采用血管内化疗栓塞术和PVP联合治疗椎体转移性肿瘤可迅速缓解椎体疼痛症状且持续时间较长,可明显提高患者的生活质量。

Objective To evaluate the clinical efficacy of vascular chemoembolization combined with percutaneous vertebroplasty for the treatment of metastatic vertebral tumors. Methods During the period from 2006 to 2010, vascular chemoembolization combined with percutaneousvertelu＇nplasty was carried oft in 25 patients （total of 32 vertebrae） with metastatic vertehral tumors. All the patients were follnwed up and the degree of pain relief was analyzed. Results Arlerial chemoemholization and percutanenus vertebrnplasty were successfully perfnrmed in all patients. In 15 patients lipindol emulsion was used as emholization agents, the average volume of iodized oil used was 1.8 ml（ 1.4±1.0 ml）. Gelatin sponge particles were used in the remaining 10 patients after the chemotherapeutic drugs were infitsed. of the total 25 patients, pain relief within one week after embolization was obtained in 20, with a remission rate of 80%. All patients sucessfully underwent vettehroplasty within one week after embnlization. Eight patients （8 vertebrae） unrlerwent bilateral vertebral puncture procedure, while the remaining patients received unilateral puncture, and the technical success rate was 100%. The mean dose of cement used for thoracic vertehrae （n = 11 ） was （3.3 ＋- 1.6） ml, and it was （4.2-＋ 1.5） ml h^r lumbar vertebrae （n = 21 ）. The average survival time afler the treatment was （10.0 ＋ 5.6） months. The effective rates fi）r pain relief evaluated at 24 hours, 1 week and 1, 3, 6 and 12 months after pereutaneous vertebroplasty were 100% （25/25）, 96% （24/25）, 84% （21/ 25）, 82.6% （19/23）, 78.9% （15/19） and 69.2% （9/13）, respectively. Conclusion For the treatment of metastatic vertebral tumors, the combined use of transeatheter arterial embolization together with pereutaneous vertebroplasty can promptly relieve the pain and maintain the remission eonditinn for a long time, theretbre, the patients＂ living qualily can be significantly improved.