脊柱转移性肿瘤的手术治疗及疗效分析

Analysis of surgical treatment and effect of spinal metastatic tumors

目的:探讨脊柱转移性肿瘤的手术治疗方法和疗效。方法:回顾性分析自2005年9月至2010年8月收治的36例接受手术治疗的脊柱转移性肿瘤患者的临床资料,其中男15例,女21例;年龄27～79岁,平均58岁。原发灶来源分别为乳腺癌、肺癌、前列腺癌、结肠癌、肝癌、食管癌、肾癌、膀胱癌,10例原发灶来源不明。肿瘤分布部位:颈椎5例,胸椎17例,腰椎13例,骶椎1例。根据Tokuhashi脊柱转移瘤的预后评分系统:0～8分9例,9～11分25例,12～15分2例。根据术前Tokuhashi评分,肿瘤侵犯的节段、范围和有无神经症状选择单纯经皮椎体成形术(percutaneous vertebroplasty,PVP)或肿瘤切除椎管减压内固定术;椎体功能重建采用钛网植入、人工椎体置换、骨水泥填塞等方法。手术前后对患者的疼痛、脊髓功能及体力状况进行评估并对患者术后3、6个月及1、2年的生存率进行观察。结果:随访2～60个月,平均10.8个月。患者术后疼痛较术前减轻或消失(P<0.05)。14例脊髓损伤的患者术后Frankel分级评估:12例分别提高1～2级。术后体力状况ECOG分级评估:28例分别提高1～2级。患者术后3、6个月及1、2年生存率分别为97.2%、63.9%、38.9%和16.7%。骨水泥渗漏6例,无严重手术并发症发生。结论:依据单发或多发转移、有无神经功能损害和脊柱失稳、全身状况选择不同的手术方法治疗脊柱转移性肿瘤,可明显减轻患者疼痛,维持和改善神经功能,改善患者生存质量,提高患者生存率。

Objective：To investigate clinical outcome of surgical treatment for spinal metastatic tumors.Methods：Thirty-six patients with metastatic spine tumors treated surgically were retrospectivly reviewed from September 2005 to August 2010.There were 15 males and 21 females with an average age of 58 years old（ranged,27 to 79 years）.The site of origin of primary cancer included the breast,prostate,colon,lung,liver,esophagus,kidney,carcinoma,bladder,and 10 patients were with unidentified primary cancer.Five lesions were located in the cervical spine,17 in the thoracic spine,13 in the lumbar spine and 1 in the sacral vertebrae.Preoperative evaluation was conducted according to Tokuhashi system：total score 0 to 8 in 9 cases,9 to 11 in 25 cases,12 to 15 in 2 cases.The surgical procedures,including PVP,tumor resection and decompression,titanium nets implant,artificial vertebra replacement,bone cement stuffiness and inter fixation,were performed based on Tokuhashi score,location of lesions and neurological symptoms.Results：All the patients were followed up,and the during ranged from 2 months to 60 months with a mean time of 10.8 months.Pain relief was obtained in all patients after operation,and the VAS pain scores declined after operation.Among 14 patients suffering from spinal cord and nerve compromise,12 patients improved 1 to 2 grades after surgery according to the Frankel grading system.According to the system of the ECOG performance status：28 patients improved 1 to 2 grades in performance status after surgery.The postoperative survival rates at 3 months,6 months,1 year and 2 years were 97.2%,63.9%,38.9% and 16.7% respectively.Six patines had bone cement leakage after PVP,and none resulted in severe complications.Conclusion：According to single or multiple spinal metastases,neurological symptoms,spinal stability and patients＇ condition,the different surgical treatments can be selected for spinal metastatic patients,which can relieve pain,maintain or improve the neurological status,improve quality of life,improve survival rate of patients.