冷循环微波灭活联合经皮穿刺椎体成形术治疗脊柱转移瘤的初步应用

The preliminary report of cooled microwave ablation combined with percutaneous vertebro plasty（PVP） in the treatment of spinal metastases

目的探讨冷循环微波灭活术联合经皮穿刺椎体成形术（percutaneous vertebro plasty，PVP）在脊柱转移瘤外科姑息治疗中应用的可行性。方法2014年2月至2017年1月对24例脊柱转移瘤患者采用冷循环微波灭活术联合PVP治疗，男14例，女10例；年龄32～73岁，平均（58．2±12．47）岁。患者术前均有局部疼痛，夜间加剧，伴有脊髓或神经根压迫症状。病变部位：胸椎14例，腰椎10例。肿瘤类型：肺癌6例、乳腺癌3例、肝癌2例、肾癌2例、胃癌1例、前列腺癌1例、卵巢癌1例、骨肉瘤1例、纤维肉瘤1例、结肠癌1例、来源不明5例。术前Tomita评分4～7分，平均（6．3-＋0．84）分，Tokuhashi评分8～11分，平均（9．3±1．27）分。23例患者接受冷循环微波灭活术联合PVP治疗，1例患者仅接受冷循环微波灭活术治疗。术后24h、3个月采用疼痛视觉模拟评分（visual analogue scale，VAS）和Frankel分级等评价临床疗效，影像学评估肿瘤局部控制率。结果24例患者均获得随访，随访时间5-36个月，平均（14．1±9．19）个月。术前测量肿瘤体积3．2～12．1cm^3，每个病椎需要灭活3～7个辐射野，每个辐射野5min，灭活时间15-35min，平均（22．1＋6．96）min。病灶内温度（56．2±5．83）℃，椎管内温度（33．6±5．14）℃。24例患者术前VAS评分与术后24h、3个月比较，差异均有统计学意义。19例患者术后3个月时Frankel分级有至少1个等级的改善。6例患者于术后5～8个月因全身多发转移死亡；9例患者随访期间有1处以上的脏器转移或骨转移，随访期间带瘤生存；余9例患者随访期间无其他部位转移。所有患者均无神经损伤及其他并发症。结论冷循环微波灭活术联合PVP能够有效地缓解脊柱转移瘤患者疼痛，解除神经压迫，重建脊柱稳定性，是一种安全、有效的姑息治疗方法。

Objective To evaluate the clinical effectiveness of the treatment for spinal metastases by cooled microwave ablation combined with percutaneous vertebro plasty（PVP）. Methods From February 2014 to January 2017,24 patients with spi- nal metastases were treated with cooled microwave ablation combined with PVP, including 14 males and 10 females with an aver- age age of 58.2 years （range, 32 to 73）. Preoperatively all the patients suffered with the local pain and the spinal cord or nerve root compression symptoms. The locations of the lesions included ： 14 in the thoracic and 10 in the lumbar. The primary tumors type： lung cancer 6 cases, breast cancer 3 cases, liver cancer 2 cases, kidney cancer 2 cases, gastric cancer 1 case, prostate cancer 1 case, ovarian cancer 1 case, osteosarcoma 1 case, fibrosarcoma 1 case, colon cancer 1 case , and unknown source tumor 5 cases. The preoperative Tomita score was 4-7 points （mean 6.3 points）, and the Tokuhashi score was 8-11 points （average 9.3 points）. 23 patients with the spinal metastatic were treated with cooled microwave ablation combined with PVP. 1 patient were treated with cooled microwave ablation only. The clinical outcomes were evaluated using visual analogue scale （VAS） and Frankel grading. The local control rate was evaluated by imaging. Results All cases were followed up for 5 to 36 months. The tumor volume size was 3.2-12.1 cm^3 by preoperative measurement. Each lesion was heated to 3-7 hot zones. Each hot zone was heated for 5 minutes. The total heating time was 15-35 minutes （mean 22.1 minutes）. The temperature inside the lesion was （56.2±5.83） ℃. The temperature inside the spinal canal was （33.6±5.14） ℃. The visual analogue scale （VAS） of the 24 patients at 24 hours and 3 months after op- eration was statistically different from the preoperative visual analogue scale （VAS）. The Frankel grading of 19 patients had at least one grade improvement 3 months after operation. 6 cases died due to systemic multiple metastases 5-8 months after surgery. 9 patients had more than one organ metastasis or bone metastasis during follow-up, and survived with tumors. The remaining 9 cas- es did not recur or transfer during the follow up period. No nerve damage or other complications were observed in all patients. Conclusion The cooled microwave ablation combined with PVP could relieve the pain in spinal metastases, relieve the nerve com- pression, and reconstruct the stability, which is a safe and effective palliative surgical method.