MR引导下聚焦超声术缓解骨转移瘤疼痛的近期疗效和安全性

Safety and sort-term efficacy of MR guided focused ultrasound surgery for bone metastasis-induced pain palliation

目的探讨MR引导下聚焦超声术（MRgFUS）缓解骨转移瘤疼痛的近期疗效和安全性。方法前瞻性收集14例骨转移瘤患者，行病变部位的MRgFUS治疗。术后对疗效进行评估，观察指标包括术前和术后1周、1个月、2个月、3个月的疼痛数字分级法（NRS）评分和标准简明疼痛量表问题调查（BPI-QOL）评分，以及术前和术后1周、3个月的卡氏功能状态量表评分（KPS）。观察患者术后不良反应。采用配对样本t检验（正态分布数据）或Wilconxon配对秩和检验（非正态分布数据）比较术后和术前疗效评分的差异。结果14例均顺利完成手术。2例患者术后退出试验观察，对12例患者进行术后随访观察疗效。术前和术后1周、1个月、2个月、3个月的NRS评分分别为6.50（4.00）、5.00（5.25）、2.50（5.00）、2.50（4.75）、2.00（6.00）分[用中位数（四分位间距）表示]，术后各时间点与术前的NRS评分差异均有统计学意义（Z值分别为－2.773、－2.740、－2.769、－2.675，P均〈0.05）。9例的NRS下降≥2分，止痛有效。术前和术后1周、1个月、2个月、3个月的BPI-QOL评分分别为（42.42±8.27）、（30.67±12.29）、（29.17±15.38）、（29.92±17.67）和（35.67±19.28）分，术后1周、1个月、2个月的BPI-QOL评分和术前比较差异有统计学意义（t值分别为3.231、2.820、2.453，P均〈0.05）；术后3个月与术前的BPI-QOL评分差异无统计学意义（t=1.286，P〉0.05）。术前和术后1周、3个月的KPS评分分别为80（28）、80（20）、65（45）分，术后1周与术前的KPS评分差异无统计学意义（Z=－1.342，P〉0.05）；术后3个月与术前的KPS评分差异有统计学意义（Z=－2.204，P〈0.05）。术后无严重不良反应。结论MRgFUS缓解骨转移疼痛近期疗效好，安全性较高。

ObjectiveTo discuss the safety and short-term efficacy of MR-guided focused ultrasound surgery （MRgFUS） for pain palliation of bone metastases patients.MethodsFourteen patients with painful bone metastases were recruited in this prospective study. The treating efficacy was characterized by numerical rating scale （NRS）, the brief pain inventory quality of life （BPI-QOL） survey, and Karnosky performance status scale （KPS）. Adverse events occurred pre-and post-treatment were analyzed. Normal distributed statistics was analyzed by using paired-samples t test or Wilcoxon rank sum test.ResultsFourteen patients were treated with MRgFUS, 2 patients dropped out of the study. The NRS ratings are 6.50（4.00）, 5.00 （5.25）, 2.50（5.00）, 2.50（4.75）, 2.00 （6.00） for pre-treatment, one week, one month, two months, and three months, respectively. Such variances of NRS ratings were statistically significant （Z=-2.773,-2.740,-2.769,-2.675; P〈0.05）. The BPI-QOL ratings were （42.42±8.27）,（30.67±12.29）, （29.17±15.38）,（29.92±17.67） and （35.67±19.28）, respectively. The BPI-QOL ratings decreased in the first two months after the treatment which is statistically significant （t=3.231, 2.820 and 2.453;P〈0.05）; whereas for the third month, the BPI-QOL rating was statistically insignificant compared with the one before the treatment （P〉0.05）.The KPS ratings were 80（28）, 80（20）, 65（45） for pre-treatment, one week and three months after treatment, respectively. Three months after the treatment, the KPS ratings decreased which was statistically significant compared with the one before the treatment （Z=-2.204, P〈0.05）. After the treatment, one patient developed deep venous thrombosis, three patients reported lower extremities numbness, two patients had soft tissue edema around the lesions.ConclusionsMRgFUS is effective for short-term pain palliation of bone metastases. Such noninvasive technique is safe and can improve patients＇ living condition.