动脉栓塞联合后路环形减压术治疗肺癌脊柱转移瘤压迫症

Preoperative arterial embolization combined with posterior circumferential decompression for metastatic epidural spinal cord compression secondary to lung cancer

[目的]研究术前动脉栓塞联合后路经椎弓根环形减压内固定术治疗肺癌脊柱转移瘤脊髓压迫症(MESCC)的疗效和预后。[方法]前瞻性纳入30例肺癌MESCC患者为试验组,先行肿瘤供血动脉栓塞,再行环形减压术。回顾性纳入单纯胸腰椎后路椎板切除椎管减压内固定术的肺癌MESCC52例患者为对照组。两组术前基线资料差异无统计学意义(P>0.05)。比较两组术中出血量、手术时间、术后神经功能状况以及生存预后。[结果]试验组术中出血量显著少于对照组[(1340.00±336.27)mlvs(2475.60±340.80)ml,P<0.05]。试验组手术时间明显低于对照组[(103.20±20.25)minvs(145.75±19.67)min,P<0.05]。试验组手术相关并发症发生率为6.67%,对照组为15.38%。术后1周Frankel分级试验组优于对照组,试验组术后1周能行走率为86.67%,对照组为65.38%(P<0.05)。试验组术后12个月生存率为30.00%,对照组为28.84%。[结论]选择性术前动脉栓塞联合后路经椎弓根环形减压术治疗肺癌MESCC是一种安全有效的方法。该方法可有效减少术中出血量、手术时间,并能改善患者术后运动功能,降低脊柱肿瘤切除术中风险,增加彻底切除肿瘤的可能性。

[Objective]To investigate the clinical outcomes and prognosis of preoperative arterial embolization combined with posterior circumferential decompression for metastatic epidural spinal cord compression(MESCC)secondary to lung cancer.[Methods]Thirty patients who were prospectively enrolled into the trial group of this study received preoperative arterial embolization followed by posterior circumferential decompression for MESCC.In addition,52 patients who had undergone simple thoracolumbar posterior laminectomy decompression combined with internal fixation for MESCC were enrolled as the control group.There were no significantly differences in baseline indicators before operation between the two groups(P<0.05).The intraoperative blood loss,operation time,neurological function graded by Frankel scale and survival prognosis were compared between the two groups.[Results]The trial group had significantly less intraoperative blood loss[(1340.00±336.27)ml vs(2475.60±340.80)ml,P<0.05],associated with significantly shorter operation time than the control group[(103.20±20.25)min vs(145.75±19.67)min,P<0.05].The early complication rate proved 6.67%in the trail group,whereas 15.38%in the control group.At 1 week postoperatively,the trial group got significantly improved neurological function graded by Frankel scale compared with that in the control group,and the 86.67%patients in the trial group returned to ambulation capacity,while 65.38%patients in the control group recovered walking(P<0.05).At 12 months postoperatively,survival rate was of 30.00%in the trial group,while 28.84%in the controlled group.[Conclusion]The preoperative selective arterial embolization followed by posterior circumferential decompression and internal fixation is a safe and effective treatment for MESCC secondary to lung cancer,with benefits of reducing intraoperative blood loss and saving operation time,which facilitates radical resection of the metastasis tumor and function recovery.