早期手术治疗脊柱肿瘤转移对预后和炎症系统的影响

Prognosis and inflammatory system analysis for early surgical treatment of spinal metastasis

目的探讨早期手术治疗脊柱肿瘤转移对于预后与炎症系统的影响。方法选择2010年8月至2013年6月间诊治的120例脊柱肿瘤患者,其中肿瘤转移80例(观察组),原发肿瘤40例(对照组),所有患者都给予切除肿瘤和重建脊柱治疗,比较两组患者预后与炎性指标间的差异。结果 120例患者均顺利完成手术,术后无严重并发症发生。手术后两组患者的疼痛评分明显低于手术前,同时观察组患者术后的疼痛评分明显高于对照组,差异均有统计学意义(P<0.05)。两组患者术前的血清白介素23(IL-23)和肿瘤坏死因子α(TNF-α)水平差异无统计学意义(P>0.05),术后观察组患者的IL-23和TNF-α水平明显高于对照组,但是均明显低于术前水平,差异均有统计学意义(P<0.05)。观察组患者的术后生活状况、家庭状况、情感状况与功能状况评分明显低于对照组,差异均有统计学意义(P<0.05)。经Kaplan-Meier生存曲线分析,观察组患者的生存时间明显低于对照组,差异有统计学意义(P<0.05)。结论脊柱肿瘤患者早期手术治疗的预后较好,但是伴发肿瘤转移能加重患者的疼痛状况、降低生活质量与生存率,其作用的发挥与炎症因子的过表达有关。

Objective To investigate the prognosis and inflammatory system analysis for early surgical treatment of spinal metastasis.Methods One120 spinal tumors patients from August 2010 to June2013 in Chenggong Hospital Affiliated to Xiamen University were selected,metastasis were 80 cases（observation group）,primary tumor were 40 patients（control group）,all patients were given to remove the tumor and reconstruction of spinal treatment.Indexes of prognosis and inflammatory system were compared between two groups.Results All patients were successfully completed surgery and had no serious complications.The postoperative pain scores in the two groups were lower than the preoperative pain scores,while the postoperative pain score of the observation group were significantly higher（P 〈 0.05）.Preoperative serum interleukin（IL）-23 and tumor necrosis factor（TNF）-α levels compared between the two groups had no significant difference,and preoperative IL-23 and TNF-α of the observation group were significantly higher（P 〈 0.05）,but all were significantly lower than preoperative（P 〈 0.05）.Postoperative living situation,family status,emotional status and functional statu scores of the observation group were significantly lower than the control group,with statistically significant differences（P 〈 0.05）.Through the analysis of KaplanMeier survival curves,the survival time of the observation group were significantly less than the control group,with significant differences（P 〈 0.05）.Conclusion Prognosis of early surgical treatment of spinal tumor patients is better,but can be associated with increased tumor metastasis in patients with pain conditions,it can reduce quality of life and survival,and it my be related to over-expression of inflammatory cytokines.