脊柱转移瘤全脊椎切除术的临床疗效分析

Clinical outcomes of total en bloc spondylectomy in spinal metastasis

目的 :探讨脊柱转移瘤行全脊椎切除术后的并发症、复发率及临床疗效。方法 :多中心回顾性收集2004年1月~2016年12月入院的共481例脊柱转移瘤患者。本研究纳入其中采用全脊椎切除术治疗的32例患者,整块切除14例,分块切除18例;男性21例,女性11例;年龄18~71岁,平均53.4±12.4岁。肿瘤原发灶:肺癌10例,乳腺癌3例,肾癌3例,前列腺癌2例,甲状腺癌2例,宫颈癌2例,胃肠道来源3例,神经系统来源(脑膜瘤、神经母细胞瘤)2例,肝癌1例,未知来源4例。随访并分析手术一般情况,术前、术后VAS评分和Frankel分级,以及术后并发症、复发、转移和生存情况。结果:平均手术时间256.9±77.1min(130~400min),术中平均出血量2160.0±1174.3ml(600~5000ml)。总体生存时间17.4±3.0个月(2~60个月),3个月生存率为96.8%,6个月生存率为73.3%,12个月生存率为44.8%。整块切除患者中位生存时间长于分块切除者(P<0.05)。术后1个月VAS评分由术前6.0±1.3分降至0.9±1.0分(P<0.05),疼痛缓解率达100%。25例伴有神经功能障碍的患者术后改善率为96%(24/25)。3例(9.4%)分别于术后4个月、6个月、12个月复发。6例(18.8%)术后1年内远处转移。9例(28.1%)术后出现并发症,其中3例内固定失败,2例术后感染(伤口处),2例脑脊液漏,1例胸腔积液伴肺不张,1例吸入性肺炎,均采取相应治疗措施后好转。结论:全脊椎切除术能明显改善脊柱转移瘤患者的神经功能并缓解患者疼痛,同时能有效控制肿瘤复发,但其仍是一种高风险、高难度、高手术并发症的手术方式。

Objectives： To investigate the clinical outcomes for total en bloc spondylectomy in spinal metas-tasis, including advantages and complications. Methods： From January 2004 to December 2016, 32 patients（21 males and 11 females） with spinal metastasis treated by spondylectomy in multicenter were reviewed, in-cluding 14 cases by total en bloc and 18 cases by piecemeal spondylectomy. Histological results included 10 cases of lung cancer, 3 cases of breast carcinoma, 3 cases of renal carcinoma, 2 cases of prostate cancer, 2 cases of thyroid carcinoma, 2 cases of cervical cancer, 3 cases of gastrointestinal cancer, 2 cases of nervous system tumor, 1 case of liver cancer, 4 cases of unknown primary cancer. The general data of operation, VAS score, Frankel grade, postoperative recurrence, complications as well as survival time were analyzed. Results：The average operation time was 256.9 ±77.1 min, the average blood loss was 2160.0 ±1174.3 ml. The average follow-up time was 20.8±3.5 months（2-72 months）, the mean overall survival time was 17.4±3.0 months（2-60 months）. Patients treated by total en bloc spondylectomy had a higher overall survival time than those by piecemeal spondylectomy（P〈0.05）. The VAS score decreased from 6.0±1.3 to 0.9±1.2（P〈0.05） at 1 month after surgery and all patients showed significant pain relief with the excellent rate of 100%. 3 cases（9.4%） had lo-cal recurrence at 4, 6 and 12 months after operation respectively. 6 cases（18.8%） had new distant metastasis in 1 year after operation. 9 cases had postoperative complications which relieved after conservative treatment.Conclusions： Total en bloc spondylectomy for spinal metastasis can significantly improve the pain and neurologic function as well as prevent local recurrence effectively. But it is still a difficult surgical procedure with high-risk and high-complications.