摘要
背景与目的:恶性肿瘤出现椎体转移并累及椎旁组织后,不仅引起疼痛,而且会导致椎体强度下降,诱发骨折,临床处理比较棘手。本研究旨在评估经皮冷冻消融联合椎体成形术治疗恶性肿瘤患者椎体及椎旁转移瘤所致疼痛的安全性和有效性。方法:回顾性分析2015年3月—2017年3月接受椎体成形术联合冷冻消融术的患者资料,纳入单一椎体和椎旁转移的恶性肿瘤患者,所有患者在相应的椎体层面伴有中、重度疼痛,并且需要服用止痛药物,其中有2例患者曾接受放疗,疼痛缓解不明显。为了控制疼痛,所有患者首先在CT引导下完成经皮冷冻消融治疗,然后转移至数字减影血管造影(digital substraction angiography,DSA)室接受椎体成形术,采用视觉模拟评分法(visual analogue scale,VAS)评分法评估患者术前及术后1、3和6个月时的疼痛程度。记录患者术前及术后的任何不适主诉。结果:共有16例患者成功接受了冷冻消融联合椎体成形术治疗,平均年龄58.1岁,其中男性10例(10/16),骨水泥平均注射量为4.2 mL。通过配对t检验,同术前相比,所有患者术后1个月的VAS评分均显著降低(P<0.05),随访3个月时进一步降低(P<0.05),6个月时稳定(P>0.05)。2例患者术后出现神经障碍,表现为股神经受损,单侧下肢麻木,抬腿困难,经过治疗后症状逐步缓解并最终消失。1例患者术后出现右侧腹壁肿胀,MRI检查显示血肿和右侧胸腔少量积液,未处理,后逐渐缓解。结论:我们的研究结果显示,经皮冷冻消融联合椎体成形术治疗单一椎体及椎旁转移瘤所致的疼痛,止痛效果明显,但有可能出现累及神经的并发症,术中需要仔细布针,结合CT引导并实时监控冰球范围。
Background and purpose: Vertebral and paravertebral metastases are the common complications in cancer patients. Although pain is the primary complaint, osteolytic bone metastasis causing vertebral compression fracture should also be considered. The aim of this study was to assess the safety and effectiveness of combined procedure of cryoablation and vertebroplasty for reduction of pain caused by vertebral and paravertebral metastases in cancer patients. Methods: We retrospectively analyzed the patients with single vertebral and paravertebral metastases who received combined procedure of cryoablation and vertebroplasty from Mar. 2015 to Mar. 2017. They also had moderate-severe pain around the level of vertebral metastasis and needed analgesic, and two of them had no pain remission after radiotherapy. In order to control the pain and treat the paravertebral neoplasm, they received cryoablation therapy followed by vertebroplasty. All the procedures were performed in CT and digital subtraction angiography(DSA) operating room. Pain intensity was evaluated by the visual analog scale(VAS) score administered before and 1, 3 and 6 months after procedure. Any uncomfortable complaint was recorded during or after operation. Results: There were sixteen patients who received cryoablation and vertebroplasty successfully. The mean age of patients was 58.1 years including 10 male patients(10/16), and the mean volume of bone cement was 4.2 m L. The VAS scores showed a reduction in all patients at 1 month postoperation compared with preoperation(paired t test, P〈0.05), further decreased at 3 months(paired t test, P〈0.05) and kept stable at 6 months(paired t test, P〉0.05). Two patients had neurological disorder after operation, and presented with femoral nerve damage symptoms, unilateral lower limb paresthesia and difficulty lifting leg. After treatment, the symptoms were gradually relieved and disappeared in the following weeks. One patient had soft tissue swelling of the right abdominal wall on the fourth day after operation. MRI showed hematoma and right-sided hydrothorax. Both patients did not receive any treatment, and symptoms were relieved later. Conclusion: This study has shown that combined procedure of cryoablation and vertebroplasty is a safe and effective procedure for pain relief in cancer patients with single vertebral and paravertebral metastases even when radiotherapy treatment has failed. In order to avoid damage to the spinal cord, careful needle positioning and accurate fluoroscopic and CT guidance are important.
作者
许立超
李文涛
王耀辉
王广志
黄浩哲
XU Lichao;LI Wentao;WANG Yaohui;WANG Guangzhi;HUANG Haozhe(Department of Interventional Radiology, Fudan University Shanghai Cancer Cente;Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China)
出处
《中国癌症杂志》
CAS
CSCD
北大核心
2018年第4期303-307,共5页
China Oncology
关键词
椎体和椎旁转移瘤
经皮冷冻消融术
经皮椎体成形术
Vertebral and paravertebral metastases
Percutaneous cryoablation
Percutaneous vertebroplasty