累及椎管内脊柱转移癌疼痛的治疗方案选择及疗效观察

Treatment options for spinal metastasis invading intraspinal area

目的探讨对于累及WBB分区D区以内的脊柱转移癌患者疼痛治疗方案的选择。方法82例累及椎管内脊柱转移癌患者分为姑息治疗组（17例）、放射综合治疗组（26例）、手术综合治疗组（39例），分别采取以对症支持治疗、放疗为主综合治疗、手术为主的综合治疗。观察治疗后1及6个月3组患者疼痛改善情况，评价不同方案对疼痛治疗效果。结果治疗后1个月姑息治疗组死亡4例，放射综合治疗组死亡1例，手术综合治疗组死亡1例；治疗后6个月姑息治疗组死亡15例，放射综合治疗组死亡11例，手术治疗组死亡5例。姑息治疗组治疗前数字疼痛评分法（NRS）评分（6．1±1．0）分，治疗后1个月（6．3±0．9）分，治疗后6个月（6．5±0．8）分；放射综合治疗组分别为（5．6±1．3）、（4．3±1．5）、（4．7±1．7）分，手术综合治疗组分别为（5．7±1．4）、（1．1±1．0）、（1．2±1．1）分。不同治疗组治疗后1和6个月的疼痛NRS评分差异有统计学意义（P〈0．01）。手术综合治疗组疼痛NRS评分改善情况优于放射综合治疗组及姑息治疗组。治疗后第1个月、6个月手术综合治疗组有效率分别为94．9％（37／38）、82．6％（32／38），放射综合治疗组为30．8％（8／26）、15．3％（4／26），止痛药物姑息治疗组均为0。结论侵犯椎管内脊柱转移癌疼痛的治疗在患者机体情况较佳情况下手术及术后综合治疗可以起到很好的治疗效果，预后也最好。一般情况较差，难以耐受手术或预计生存期小于6个月的患者采用局部放疗及其他综合治疗，可起到一定效果，但较难巩固。一般情况很差，机体处于衰竭前期的患者建议保守治疗，疼痛缓解效果差，预后差。

Objective To investigate pain treatment options for spine metastases invading WBB partition （D）. Methods Eighty-two patients with spinal metastasis invading WBB partition （D-E） were divided into three groups： palliative treatment group（ seventeen cases）, radiation and combined therapy group（ twenty-six cases） and surgical and intergrated therapy group（ thirty-nine cases）. The pain improvement observed one month and six months after main treatment. Different schemes for pain treatment with spinal metastasis invading intraspinal area were evaluated and treatment options were discussed. Results One month after therapy, four patients of inpalliative treatment group, one patient of radiation combined treatment group and one of surgical and integrated treatment group died. After six months, fifteen patients of palliative treatment group, eleven of radiation combined treatment group, five of surgical and integrated treatment group died. Before therapy, one and six months after therapy, nutrition risk score （NRS） pain score and curative effect of each group were collected [ palliative treatment group ： （6. 1 ± 1. 0） scores, （6. 3 ± 0. 9 ） scores, （6. 5 ± 0. 8 ） scores ; radiation and combined therapy group ： （5.6 ± 1.3） scores, （ 4. 3 ± 1.5 ） scores, （ 4. 7 ± 1.7 ） scores; surgical and intergrated therapy group： （ 5.7 ± 1.4） scores, （ 1.1 ± 1.0） scores, （ 1.2 ± 1.1 ） scores]. NRS scores of surgical and intergrated therapy group were improved more than those of radiation and combined therapy group or palliative therapy group. Effective rates of surgical and intergrated therapy group were 94.9% （37/38）, 82. 1% （32/38）. Effective rates of radiation and combined therapy group were 30. 8 % （8/26）, 15.3 % （4/26）. Effective rates of palliative treatment group were 0. Conclusions Patients with good body condition and intraspinal area involved with spinal metastasis can get good pain improvement via surgical and integrated treatment. Operation and postoperative comprehensive treatment can play a very good therapeutic effect. Among patients with poor general condition, expected survival less than 6 months, local radiotherapy and other comprehensive treatment, there is a certain effect but difficult to consolidate. When the patient＇s general situation is very bad, recommended conservative treatment can get poor effect and poor prognosis.